NEW YORK — U.S. doctors and teaching hospitals were paid $3.5 billion by drug and device makers over five months in 2013, according to the first comprehensive disclosure of the companies’ financial ties to the medical professionals that prescribe and use their products.

The disclosures by the U.S. government cover 4.4 million payments to about 550,000 doctors and 1,360 teaching hospitals from August to December 2013. The companies had to provide the information as part of the 2010 Patient Protection and Affordable Care Act, often known as Obamacare.

While doctors are allowed to prescribe any treatment they think will help a patient, makers of drugs and medical devices are allowed to market products only for uses the Food and Drug Administration has reviewed and approved. In some cases, companies have used their financial links to the medical community to get around that limitation, according to critics.

The payments “really have an insidious corrupting influence on the practice of medicine, research, the development of clinical guidelines and clinical practice,” said Michael Carome, the director of health research at the nonprofit watchdog group Public Citizen. “The reason companies pay physicians honoraria and give them gifts and consulting fees is ultimately to influence the prescribing practices of physicians.”

The U.S. said the motives and consequences are far more complex. The data don’t “identify which financial relationships are beneficial and which could cause conflicts of interest,” said Shantanu Agrawal, director of program integrity at the Centers for Medicare and Medicaid Services. While the disclosure may help stop inappropriate payments, “they could also help identify relationships that lead to the development of beneficial new technologies.”

Past analyses have found that “off-label” uses made up a fifth of prescriptions, and companies have sometimes stepped over the line in what they can tell prescribers. In the past decade, drug companies paid billions of dollars in legal settlements after a series of lawsuits by the Justice Department, many of which targeted drugmakers for pushing unapproved uses of their products.

GlaxoSmithKline pleaded guilty in July 2012 to illegal promotion of two drugs as part of a $3 billion settlement, the largest ever in a health-care fraud case in the U.S.

Other drugmakers that have paid settlements include Merck & Co., Amgen, AstraZeneca and Pfizer, which paid a $2.3 billion settlement in 2009.


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