It’s enough to give one a migraine.

Last Friday, just hours before President Trump illegally fired Christi Grimm as Inspector General of the Health & Human Services Department (along with 16 other inspectors general), her office and the Department of Justice successfully forced Pfizer Inc. to pay $60 million to settle charges it improperly marketed an anti-migraine drug.

A 2022 law strengthening the independence of in-house watchdogs at federal agencies requires the president to give Congress at least 30 days advanced notice before firing an IG. POTUS must also provide Congress with a detailed legal justification for any dismisssal.

The president’s contempt for the law parallels Pfizer’s alleged illegal activity. According to the settlement reached Friday, the company’s drug salespersons paid physicians “in some cases more than a hundred thousand dollars” to speak on behalf of Nurtec ODT, an anti-migraine drug. The speeches took place at dinner meetings attended by the speakers' family members, friends and colleagues from their own practice.

“Providers received no educational benefit from attending these meetings,” the settlement said. The subsidiary “intended the purchase of meals and drinks to induce these providers to prescribe Nurtec ODT.”

Why must Pfizer give financial inducements to doctors to convince them to prescribe a drug that helps people with a debilitating condition like migraines? One doesn’t have to look far for the answer to that question. Nurtec ODT’s topline celebrity promoter — Lady Gaga — offers only a half-hearted endorsement on the company’s website. “If you're, like me, one of the millions suffering from pain caused by migraine, Nurtec ODT may help,” she says.

“May” is the operative word. According to the Food and Drug Administration label on Nurtec, popping the pill ended migraine pains within two hours for just 21 percent of patients. That compared to 11 percent among those taking a placebo. It reduced major symptoms like nausea and light sensitivity in 35 percent of patients taking the drug compared to 27 percent among those taking a placebo.

In other words, Nurtec ODT was barely better than nothing. Two-thirds of patients received no benefit at all.

Cracking down on illegal marketing is only one of the crucial functions played by the Office of the Inspector General at HHS. Since 2007, the OIG and the Department of Justice have been operating a special joint task force to root out waste, fraud and abuse in a dozen major metropolitan areas.

“The Health Care Fraud Unit has charged more than 5,400 defendants with fraudulently billing Medicare, Medicaid, and private health insurers more than $27 billion,” a recent DOJ blog post noted. “In recent years, the average loss associated with the schemes prosecuted by the Health Care Fraud Unit has steadily risen, underscoring our focus on the most egregious offenders.”

Pill mills a target

One of the more significant recent cases took place in Alabama, where in 2023 an opioid pill-mill operator and his wife were sentenced to 20 years in prison for illegally distributing controlled substances and committing health care fraud. This was one of the first cases that Grimm, who has been with the agency since 1999, brought to a successful conclusion after becoming IG the previous year.

“At trial, evidence showed that the physician and his wife operated pain clinics in which patients often received pre-signed prescriptions that were issued to patients who went months or years without being seen by the doctor,” the joint task force’s most recent annual report said. “The doctor was responsible for writing prescriptions for over 10 million opioid pills and he and his wife also participated in fraud and kickback schemes that billed public and private insurance programs for over $270 million in fraudulent claims.”

You would think someone who wants to make American healthy again, and help some of his most loyal constituents avoid being victimized by illegal pill-mill operators, would want someone like Grimm to run HHS’s watchdog agency. The OIG’s semiannual reports to Congress estimated the agency recovered close to $10 billion for Medicare and Medicaid in 2024, nearly 20 times the 1,500-person agency’s annual budget.

Much of the HHS-DOJ task force’s efforts in recent years has focused on cracking down on opioid abuse. It set up special offices in New England and Applachia. It also stepped up efforts in traditional hotbeds of Medicare fraud: Texas and Florida, both of which have two major task force offices dedicated to combating illegal billing.

Here’s hoping a federal judge capable of reading the plain letter of the law will force Trump to rescind these illegal firings and submit the necessary paperwork. He offered nothing last Friday to justify removing these career professionals, almost all of whom came up through the ranks and dedicated their professional lives to protecting taxpayers, program integrity and current and future beneficiaries of important government programs.

Since I’ve began covering health care more than two decades ago, the HHS OIG has always been headed by a career professional. Dan Levinson, who retired in 2019, had been there for 15 years. When he left, Alex Azar, HHS secretary during Trump’s first term, said “Under Dan’s leadership, the HHS Office of Inspector General (OIG) has done tireless, invaluable work to protect program beneficiaries and taxpayer funds, improve the management and integrity of HHS programs, and respond to emerging challenges such as the ongoing opioid crisis.”

This time around, there’s widespread fear that the mission of the OIG will be undermined if Trump gets away with turning the job into a political appointment. “President Trump is dismantling checks on his power and paving the way for widespread corruption,” Sen. Elizabeth Warren (D-MA), said on Friday after the president’s announcement.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.