Insurance Fraud NEWS
Multistate opioid fraud, fraud bust snares 31 docs, 8 nurses, 7 pharmacists
April 18, 2019, Washington, DC
Sixty people in eight states face criminal charges for allegedly illegally prescribing and distributing opioids and other narcotics, and for healthcare fraud, the Department of Justice said.
The defendants include 31 physicians, eight nurse practitioners, seven pharmacists, and seven other licensed medical professionals, most of them practiciting in Appalachia, DOJ said in a media release.
"The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region," Attorney General William P. Barr said.
Barr credited DOJ's four-month-old Appalachian Regional Prescription Opioid Strike Force with spearheading the investigations that led to this week's arrests.
The defendants were charged with unlawful distribution of opioids and other prescription narcotics, along with various fraud-related offenses in 10 federal districts in Ohio, Pennsylvania, Louisiana, Virginia, West Virginia, Kentucky, Tennessee, Alabama.
"Today's takedown demonstrates the FBI’s unwavering commitment to working alongside our Strike Force partners, including the HHS-OIG and DEA, to fight the opioid epidemic and related criminal activity in the Appalachian region," said FBI Executive Assistant Director Hess. "We will not stand by and allow the harmful and oftentimes deadly practice of over-prescribing highly addictive drugs to continue unchecked. The FBI will pursue medical personnel who misuse their positions of trust to blatantly disregard others' very lives for their own financial gain."
About 130 people die every day of an opioid overdose, according to the Centers for Disease Control and Prevention.
Among the more egregious allegations detailed by the DOJ:
In Ohio, a doctor who is alleged to have been at one time the highest prescriber of controlled substances in the state, and several pharmacists are charged with operating a pill mill in Dayton, Ohio. According to the indictment, between October 2015 and October 2017 alone, the pharmacy allegedly dispensed over 1.75 million pills.
In Kentucky, a doctor allegedly provided pre-signed, blank prescriptions to office staff who then used them to prescribe controlled substances when he was out of the office, and for directing staff at the clinic, including individuals not licensed to practice medicine, to perform medical services on patients.
A solo practitioner who operates a five-clinic family practice focusing on pain management allegedly billed Medicare for urine testing that was not done and for urine testing that was not medically necessary.
A dentist allegedly wrote prescriptions for opioids that had no legitimate medical purpose and that were outside the usual course of professional practice, removing teeth unnecessarily, scheduling unnecessary follow-up appointments, and billing inappropriately for services.
A doctor was charged for allegedly prescribing opioids to Facebook friends who would come to his home to pick up prescriptions, and for signing prescriptions for other persons based on messenger requests to his office manager, who then allegedly delivered the signed prescriptions in exchange for cash.
In Tennessee, two cases involve doctors who were previously sanctioned by the Tennessee Medical Board in connection with the overprescribing of opioids, one of whom was sanctioned for providing prescriptions to vulnerable patients, while the other allegedly prescribed opioid pills after serving a probation.
A nurse practitioner who branded himself the "Rock Doc," allegedly prescribed powerful and dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors.
One doctor allegedly prescribed approximately 500,000 hydrocodone pills, 300,000 oxycodone pills, 1,500 fentanyl patches, and more than 600,000 benzodiazepine pills over three years.
In another case, a nurse practitioner charged with conspiracy to unlawfully distribute controlled substances allegedly prescribed over 500,000 Hydrocodone pills, approximately 300,000 Oxycodone pills, and approximately 300,000 benzodiazepine pills (mostly Alprazolam), along with a myriad of other controlled substances.
In another case, a physician charged with controlled substances and health care fraud violations allegedly prescribed approximately 300,000 hydrocodone pills, 200,000 oxycodone pills, 2,500 fentanyl patches, and 180,000 benzodiazepine pills, and prescribed medically unnecessary durable medical equipment that was billed to Medicare.
Another doctor charged with controlled substances violations allegedly prescribed approximately 4.2 million opioid pills, sometimes in dangerous combinations with other drugs, such as benzodiazepines, and prescribed opioids to known addicts.
In Alabama, a doctor allegedly prescribed opioids in high dosages, dangerous combinations, and in many cases, after having knowledge that patients failed drug screens and were addicts, preferring cash payments and charging a "concierge fee" that ranged from approximately $50 per visit or $600 per year.
In another case, a doctor allegedly recruited prostitutes and other young women with whom he had sexual relationships to become patients at his clinic, while simultaneously allowing them and their associates to abuse illicit drugs at his house.
In West Virginia, an orthopedic surgeon allegedly used fraudulent prescriptions to obtain tablets of acetaminophen-codeine for his own use. To obtain the pills, the surgeon allegedly wrote out prescriptions using his DEA number, and in the names of a relative, using a driver's license that he had stolen from a colleague to obtain the pills from pharmacy.
Source: Health Leaders