Articles Posted in Doctor Shopping

Photobucket SOUTH FLORIDA (AUGUST 18, 2011) – The new legislation designing to halt the sale of painkillers and close down the largest pill mill industry in the nation, doesn’t target the real source of the problem it seems. Pharmacies, not doctors, sell about 80 percent of the narcotic painkillers that people get their hands on through doctor shopping.
A new state-wide database may cut that problem down, but the startup of the database has been stalled. Officials have rededicated their efforts to have the database up and running later this year. The database is designed to catch patients who jump from one doctor to the next, or who “doctor shop,” in order to keep their high prescription narcotic use under wraps. When a patient gives their prescription to a pharmacist, their name, doctor name and prescription drug information will be entered into a computer system. The system will flag any patients who attempt to buy more narcotics within too short a period of time.
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Photobucket LAKE WORTH, FLORIDA (May 18, 2011) – The DEA’s Operation Pill Nation

crackdown thought it was just another pill mill investigation, but in a strange twist the agency also found that Dr. Cesar DeLeon, a Lake Worth physician was not operating the typical pill mill out of his clinic, the Trinity Medical Center. The doctor received methods of compensation other than money for prescriptions; he was sometimes paid with sex.

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PhotobucketWASHINGTON D.C. – Peter Budetti, Washington’s watchdog for Medicare and Medicaid fraud warns would-be program fraudsters that he’s cracking down and plans to use technology and a new long-range, far-reaching strategy to do it.

The FBI estimates figures in the double- to possible triple-digit billions are lost annually to healthcare fraud, and the State of Florida, due to its high elderly population, leads the country in Medicare scams. Medicare fraud isn’t limited to criminal practices by healthcare professionals, including nurses, doctors and pharmacists, but also business owners, Medicare beneficiaries, drug dealers and even organized crime groups defraud the fund.

The Crackdown

PhotobucketPALM BEACH COUNTY, FLORIDA (May 14, 2011) – South Florida, usually a premier destination for those desiring beautiful beaches, fine dining and luxury accommodations has become a major draw for out-of-state drug traffickers seeking, among other drugs, the popular narcotic painkiller, Oxycodone.

The out-of-towners, called “pillbillies” because of their connection to the Appalachian region, buy large quantities of prescription drugs, then head back to their home state to sell them. Local law enforcement resources have become overtaxed due to the large number of these out-of-state defendants frequently caught during a routine traffic stop.

The majority of offenders hail from Ohio, Tennessee and Kentucky and for the last five years, “pillbillies” have clogged up the Broward County court docket, which ultimately hits local residents’ wallets. One day in jail costs the county $114 for each jailed defendant.

money-pile.jpgTALLAHASSEE, FLORIDA (May 10, 2011) – Florida’s legislature scored a big win with the passage of the bill to target pill mills, prescription drug dealers and users. Supporters of the bill consider the loopholes minor.

House Bill 7095 bill makes provisions for a state prescription database and requires drugstores to log the sale of every prescription pain pill. It does not, however, require doctors and pharmacists to check the database before handing the patient their pills. Mandating a database check could catch abusers through cross-referencing all places where they fill prescriptions.

Certain doctors and practices also fall under an exemption for registration with the database. Board-certified pain specialists, such as anesthesiologists, neurologists and surgeons can dispense pain meds without registering the transaction. Non-exempt physicians must register their office, have an inspection and follow set standards of patient care. With more than one-half of Florida’s pain clinics run by board-certified pain doctors, potential for abuse runs high. State officials offer that the class of exempted doctors generally are much less likely to abuse the system.

u_s_capitol_building.jpg WASHINGTON D.C. (May 6, 2011) – U. S. Senator Sherrod Brown (D-OH) has introduced the “Stop Trafficking of Pills Act’’ or the ‘‘STOP” Act target patients and drug dealers looking for narcotic pain medications. The Senator wants individual states to take a tougher stance in fighting Medicaid fraud where prescription medications are involved.

Last year Medicaid shelled out $820 million for prescription drugs in Ohio alone last year. Drug seekers use their Medicaid card to go from doctor to doctor and pharmacy to pharmacy, and although Florida boosts the highest number of Oxycodone prescriptions filled yearly, Ohio ranks number two. The Senator claims Oxycodone, morphine and methadone are the increasing deaths and overdoses.

Senator Brown’s bill would require patients to “lock-in” their choice of a Medicaid provider and pharmacy, which is already required in many states now. The Ohio Highway Patrol has already been targeting prescription pill couriers on Ohio’s interstates. In March alone, more than 1300 arrests were made for illegal prescription pills. One of the biggest corridors, for illegal prescriptions drugs, runs from Detroit, Michigan to southern Ohio before filtering into other states.

doctor-writing-prescription.jpgCOLUMBUS, OHIO (May 9, 2011) – Joining other states with similar legislation, Ohio’s licensed doctors support the passage of regulations to curb the ‘pill mill’ problem and cut the rapid growth of the painkiller-addiction problem in the state. The physicians are also concerned, however, that patients with legitimate pain relief needs could find it harder to come by their drugs, if doctors are worried they’ll be targeted for investigation. “Nothing about anything that we’re doing is meant to dissuade good physicians,” states Richard Whitehouse, executive director of the State Medical Board. Instead, the aim is to give the board more authority to target pill mills.

Ohio House Bill 93 seeks pharmaceutical licensure of free-standing pain management clinics, which is where the majority of patients receive the narcotic pain killers. In addition, doctors would be required to have an affiliation with a local hospital and be board-certified in pain management. Doctors would also have to report any narcotic pain prescriptions written to a state-monitored automated reporting system.

In the past, physicians prescribed strong pain killers mostly to their cancer patients. After reevaluation of pain as the “fifth” vital sign, doctors began to more freely write for pain killer medications. “Now, there’s a crisis of drug abuse and diversion,” states Dr. Robert Taylor of Ohio State University Medical Center.

PALM BEACH, FL – Palm Beach County State Attorney Michael McAuliffe announced the arrest and filing of criminal charges against 11 individuals, including five physicians, for a total of 172 counts which include Racketeering (RICO), Conspiracy to Commit Racketeering, Trafficking in Oxycodone, Money Laundering, Unlicensed Practice of Health Care Profession and other related criminal charges. The arrests follow a complex multi-agency investigation dubbed OPERATION “PILL NATION” involving roughly 340 undercover buys from doctors and medical personnel in pain clinics throughout a three county South Florida area.

OPERATION “SNAKE OIL” (click here to see an earlier post about this) also carried out the same day as “OPERATION “PILL NATION” is a result of the ongoing efforts by the Organized Crime Drug Enforcement Task Force (OCDETF), a partnership between federal, state and local law enforcement agencies. The OCDETF mission is to identify, investigate, and prosecute high level members of drug trafficking enterprises, bringing together the combined expertise and unique abilities of federal, state and local law enforcement and being prosecuted by the federal authorities.

“Legitimate pain management is a essential part of medical practice,” however “we cannot, and will not, allow medicine to be used by merchants of misery to corrupt the health of individuals and undermine the welfare of whole communities. We are in a continuing crisis, but the tide is turning and today’s enforcement actions provide a clear example of progress,” said State Attorney McAuliffe. To read the State Attorney’s Office’s Press release in its entirety, click here.

Pain Management, among other forms of drug related treatment, has been receiving substantial scrutiny lately. Unlike some other fraud or abuse investigations predicated upon whether services were provided or claims were fraudulent, the primary focus is the treatment, why the physician is issuing particular prescription(s). In prescribing medications, are physicians treating patients or are they merely feeding client drug habits for a price?

The DEA has been aggressive in investigating and prosecuting some physicians for over prescribing medications. However, on the legislative side, federal law has lagged because the issue relates the practice of medicine itself, which is a state issue, not federal. The Ryan Haight Act, to outlaw most internet pharmacy operations, is a notable exception. The statute specifically prohibits a physician from issuing a prescription for a controlled substance where the internet is involved unless there has been at least a physical examination of that patient. Many states have tightened up statutes related to certain types of treatment: pain, weight loss, drug abuse treatment among others.

In conducting their investigations the authorities are relying more and more on numbers as an indicator of guilt, that is the amount of drugs prescribed and ordered. This year, Florida joined a number of other states in passing legislation to track controlled substance prescriptions by all providers in the state. The purpose is investigative, to focus in on physicians and patients, to prevent over prescribing of medications, prevent doctor shopping and to shut down purported “pill mills.”