S. E. Williams
Federal Government Targets Health Care Professionals Complicit in Opioid Misuse and Abuse
When U.S. Attorney General Jeff Sessions announced the results of the Justice Department’s recent Health Care Fraud Takedown event he said, “Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients. Amazingly, some have made their practices into multi-million-dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed.”
Sessions made this statement last Thursday, when the U.S. Department of Justice (DOJ) shared results of the largest health care fraud enforcement action in its history. The action, led by the Medicare Fraud Strike Force, resulted in the arrest and charge of 412 defendants across 41 federal districts, including 115 doctors, nurses, and other licensed medical professionals for their alleged participation in health care fraud schemes that involved nearly $1.3 billion in false billings.
According to the DOJ, among those charged, more than 120 of the defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
The charges, officials explained, targeted schemes that billed Medicare, Medicaid, and TRICARE (a health insurance program for veterans and members of the armed forces and their families) for, “medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries.”
At least thirty state Medicaid Fraud Control Units, including California, participated in the arrests. In addition, the Department of Health and Human Services initiated suspension actions against 295 providers, including doctors, nurses, and pharmacists.
Many of the charges involved individuals contributing to the opioid epidemic, with special focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics. According to the Center for Disease Control, approximately 91 Americans die every day of an opioid-related overdose.
Sessions said the actions of these professionals not only enrich themselves often at the expense of taxpayers, but they also feed addictions and cause addictions to start and the consequences are very real: “emergency rooms, jail cells, futures lost, and graveyards.”
According to court documents reviewed by the Voice/Black Voice News, some of the cases involved patient recruiters, beneficiaries, and other co-conspirators who were purportedly paid cash kickbacks in return for supplying beneficiary information to providers, so the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.
Last year, nearly 59,000 Americans died due to drug overdoses, many related to the use of prescription drugs. As noted in the DOJ report, the number of medical professionals charged this year is particularly significant because virtually every health care fraud scheme requires a corrupt medical professional to be involved for Medicare or Medicaid to pay the fraudulent claims. “Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system,” the DOJ reported.
Last week’s enforcement action reached up and down the state of California. In the Central District of the state, 17 defendants were charged for their roles in schemes to allegedly defraud Medicare out of nearly $147 million. Two of the defendants were indicted for their purported involvement in a $41.5 million scheme to defraud Medicare and a private insurer. They allegedly submitted fraudulent claims and received payments for prescription drugs that were not filled by the pharmacy, nor given to patients.
In the Eastern District of California last week, cases and investigations by the U.S. Attorney’s Office resulted in the execution of search warrants in those investigations.
In the Northern and Southern Districts of California, four defendants, including at least one doctor, were charged for their roles in a drug diversion scheme and health care fraud scheme that involved kickbacks.
The Voice/Black Voice News reviewed court documents related to the Southern California case: United States of America v. Thomas S. Powers, M.D. and Anthony Paduano. This review revealed that Paduano, through his business, Accolade Equity LLC, entered into a contract agreement with a pharmacy, TC Medical Pharmacy (TCMP) in Corona. Beginning at an unknown date and continuing to about June 2015, in Orange and Riverside Counties, an individual described as Schemer #1 allegedly paid Paduano a fee of about 40 percent of the reimbursement that TCMP would receive from TRICARE for filling compounded medication prescriptions, for referral his referral to TCMP.
Compounding is a practice by which a licensed pharmacist or physician combines, mixes, or alters ingredients of a drug or drugs to create a drug tailored to the needs of an individual patient. Compound drugs are not FDA approved but can be prescribed by a physician when an FDA approved drug does not meet the needs of a particular patient. According to Express Scripts, “compounded drugs” ranked as the third most expensive drug class in 2014, after diabetes and high cholesterol medications.
Paduano would allegedly solicit TRICARE beneficiaries to seek compounded medications in exchange for payment and to refer other TRICARE beneficiaries to him, in exchange for payment of a referral fee. Paduano and Powers purportedly had an agreement by which Paduano paid Powers $200 per individual to write a prescription that called for compound medications.
Schemer #1 and others would then fill the prescription on behalf of TCMP, referred by Paduano, and submit a claim to TRICARE for reimbursement. Schemer #1 would subsequently pay Paduano a referral fee for each prescription.
While the Attorney General praised the success of last week’s operation and pointed to the 295 health care providers in the process of being suspended or banned from participation in federal health programs, he also stressed the significance of the 120 defendants charged with opioid related crimes. As an example, he cited the Michigan scheme of six doctors who allegedly have prescribed patients with unnecessary opioids, some of which ended up for sale on the street.
In another example, he cited an illegal clinic in Houston that allegedly gave out prescriptions for cash. Just one doctor at this clinic reportedly wrote 12,000 opioid prescriptions for over two million illegal painkiller doses.
Locally, Riverside and San Bernardino Counties are working to keep abreast of the growing impact of opioid abuse in the inland region. This week, Dr. Cameron Kaiser, Riverside County Health Officer, Department of Public Health, shared his insights regarding the impact of opioid addiction in the Inland Empire.
From 2012 to 2016, the raw number of opioid-related deaths in the area were 491 according to the department. This was just an estimate, as there are many deaths labeled multi-drug or other. Also, the deaths identified as opioid-related were not solely the result of opioids; some may have resulted from a combination of fentanyl and alcohol, or heroin and cocaine, or a concoction of oxycodone and alcohol and other drugs.
When Dr. Kaiser was asked about the impact of opioids on residents of Riverside County he replied, “I think the best way to describe it is that it is going to become a larger and larger problem over time.”
He continued, “When you deal with it in the health care setting, you see it from a different perspective.” According to Dr. Kaiser, about ten years ago, it appeared the medical community was not doing enough to help patients manage their chronic pain. It is possible the pendulum may have swung too far in the other direction. “As a result,” Dr. Kaiser said, “we have a generation of people who are more dependent.”
Dr. Kaiser expressed his belief that as the federal government cracks down on other kinds of drugs, opioids can become a gateway to addiction. “In Riverside County, even though we have relatively low numbers, we see people going on to use these drugs on a lifetime basis, so we want to get ahead of the problem.”
According to Dr. Kaiser, when it comes to opioid abuse, Riverside has a supply problem and a demand problem. From a supply perspective regarding prescription pain killers (not heroin), “When people get hooked on Vicodin and Norco in our county, we have the Inland Empire Opioid Task Force in partnership with San Bernardino County.” He explained that the Task Force identifies emergency room best practices to assure opioids are not being handed out indiscriminately. From a demand perspective, Dr. Kaiser stressed, “Patients need to realize that [pain] medications come at a cost—some people can handle them, others cannot.” He added, “We need to make sure non-opioid alternatives have been tried, such as diet, exercise, etc.”
Dr. Kaiser further noted that demand can come from people already hooked. “We need to get them connected to care.” The biggest challenge in Riverside County, he shared, is, “We have limited pain management and drug abuse programs. We need more. We want to intervene before they get involved in the legal system… There are many patients that are willing, but our resources are so limited.”
Dr. Kaiser also addressed concerns that a growing number of seniors may be becoming dependent on opioid medications due to chronic pain. “We’ve had some discussion about people who have accrued chronic pain,” he said and stressed the need for even more discussion.
In conclusion, Dr. Kaiser shared one of his key concerns regarding the potential opioid crisis is the inland region: “I think it is worth pointing out that we don’t want this to exacerbate existing disparities between communities. We don’t want it to impact communities without resources.”