Opioid Crackdown Requires Increased Focus on Compliance

It’s not just drug dealers and traffickers selling opioids who have become the target of law enforcement. Earlier this month, the Department of Health and Human Services Office of the Inspector General, along with state and federal law enforcement partners, targeted healthcare providers.

The agency announced that 412 defendants including 115 doctors, nurses and other licensed medical professionals, were charged with taking part in healthcare fraud schemes involving approximately $1.3 billion in false billings. Of those charged, more than 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

In addition, HHS is in the process of excluding 295 providers, including doctors, nurses and pharmacists from participating in federal healthcare programs.

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.

According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers

Around the same time as the arrests, the OIG issued a data brief, which the agency noted is part of a larger strategy fight in the opioid crisis and addresses one of its top priority outcomes – “to protect Medicare beneficiaries —and the community as a whole — from prescription drug abuse.”

The brief noted four key takeaways:

  • One in three Medicare Part D beneficiaries received a prescription opioid in 2016.
  • About 500,000 beneficiaries received high amounts of opioids.
  • Almost 90,000 beneficiaries are at serious risk; some received extreme amounts of opioids, while others appeared to be doctor shopping.
  • About 400 prescribers had questionable opioid prescribing patterns for beneficiaries at serious risk.

The data brief includes in-depth analysis of opioid utilization among Medicare Part D beneficiaries. This means that federal agencies are mining data to determine who is prescribing opioids and to whom.

While the majority of healthcare providers are honest, ethical and legitimate, the government’s increasing interest in cracking down on opioid use may result in some being caught up in the wide net being cast. Healthcare providers who are viewed as outliers in prescribing opioids to Medicare patients are even more likely to become potential targets for enforcement actions. If you are prescribing opioids and other prescription drugs, you would be well advised to make sure you are doing so legally and in the best interest of your patients.

Providers must ensure that their practice is in compliance with federal and state laws that govern the prescription, dispensing, and distribution of all prescription medications.

The Health Law Offices of Anthony C. Vitale can assist healthcare providers and organizations at all levels of an investigation. Call us at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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The Health Law Offices of Anthony C. Vitale