The Center for Public Integrity

Tons of imported fish laced with chemicals banned from the U.S. food supply, including carcinogens, are routinely showing up in this country and, state officials say, winding up on American dinner plates.

Within the last two months, three American fish importers pleaded guilty in Mobile, Ala., to federal felony charges of mislabeling fish and seafood. Their illegal haul included more than 120,000 pounds of imported fish, brought in to Mobile and Seattle, that tested positive for the suspected human carcinogen malachite green and for another antibiotic that U.S. authorities also prohibit for use on fish that people consume.

What’s more, FairWarning found that states including Arkansas, Tennessee, Georgia, Alabama and Florida have detected evidence of prohibited substances in recent years while screening imported fish.

"I can tell you right off the bat that 40 percent of the imported fish we test is positive for banned drugs that are not safe for human health," said Brett Hall, deputy commissioner for the Alabama Department of Agriculture and Industries.

The evidence of tainted imported fish reaching U.S. shores and seeping into the marketplace fleshes out a critical Government Accountability Office audit released in April. The year-long investigation found that the Food and Drug Administration’s inspection system is so haphazard in inspecting imported fish and seafood— screening less than 1 percent of what comes in  -- that fish tainted with potentially harmful drugs "may be entering U.S. commerce." The report noted that more than 80 percent of the fish Americans eat is imported from other countries.

An inspector general review found that nine of 10 Medicare claims for atypical antipsychotic drugs for nursing home patients were given for dementia, despite warnings of increased death rates.

According to the Department of Health and Human Services inspector general, 14 percent of 2.1 million nursing homes had at least one claim for antipsychotic drugs and out of those patients, 17 percent were taking more than one antipsychotic.

The Food and Drug Administration requires drug manufacturers to include a warning explaining the increased risk of death when these drugs are used for the treatment of behavioral disorders in elderly patients with dementia. Elderly patients with dementia taking anti-psychotics experienced a death rate of 4.5 percent, compared to 2.6 percent in placebo groups. According to the IG, 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with off-label usage and 88 percent were associated with dementia.

Off-label use—prescribing a medication for a condition other than the FDA-approved use— is not uncommon. Anti-psychotic medicines have been used to treat agitation in dementia, depression, obsessive-compulsive disorder, post-traumatic stress disorder, personality disorders, Tourette’s syndrome and autism.

While doctors are not prohibited from prescribing drugs for off-label conditions or in the presence of conditions specified in an FDA warning, such as dementia, Medicare will pay only for drugs that are used for medically accepted indications approved by FDA. The IG review of medical records determined that 22 percent of the atypical antipsychotic drugs did not comply with CMS standards regarding unnecessary drugs in nursing homes, amounting to $63 million of claims.