Opioids: Healthcare Fraud Takedown

Rhonindk

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"Federal authorities announced charges Thursday against 412 physicians, nurses, pharmacists and other medical professionals, in what Attorney General Jeff Sessions called the largest health care fraud enforcement operation in U.S. history.

Sessions said suspects accounted for more than $1.3 billion in fraudulent transactions across more than 20 states, and at least 120 people were charged for their alleged roles in over-prescribing and distributing opioids, making it also the largest-ever opioid-related fraud takedown.

Of the 412 charged in the year-long operation, 56 were physicians.

"Too many trusted medical professionals...have chosen to violate their oaths and put greed ahead of their patients,'' Sessions said. "Amazingly, some have made their practices into multi-million dollar criminal enterprises.''"


https://www.usatoday.com/story/news/politics/2017/07/13/jeff-sessions-authorities-charge-400-people-health-care-fraud/475089001/

Looks like this finally went somewhere. Good to see that group is doing something with this.
 

A.Goldberg

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Good. It's about time they start cracking down federally on pill mills and other negligent prescribers.

Fine them, use the money to support drug treatment, put them in jail, and strip them of their medical license.

I'd suggest investigating the patients too. A lot of the illegal prescriptions that end up on the street come from patients who doctor shop these fraudulent healthcare providers.
 

Rhonindk

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steve knight

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How the hell would you hold the drug companies at fault? Want to go after them for antibiotic resistance as well?
they knew fraud was going on the amount of drugs they sold was way over the top.
https://www.theatlantic.com/business/archive/2017/06/lawsuit-pharmaceutical-companies-opioids/529020/
Opioid abuse is rampant in states like Ohio, where paramedics are increasingly spending time responding to overdoses and where coroners’ offices are running out of room to store bodies. In 2012, there were 793 million doses of opioids prescribed in the state, enough to supply every man, woman, and child, with 68 pills each. Roughly 20 percent of the state’s population was prescribed an opioid in 2016. And Ohio leads the nation in overdose deaths.

Who is responsible for this? Some attorneys general and advocates are now asking in court whether the pharmaceutical companies who marketed the drugs and downplayed their addictive nature can be held legally responsible for—and made to pay for the consequences of—the crisis. This may not be such an outlandish idea; in fact, there’s a good precedent. In 1998, the tobacco industry, 46 states, and six other jurisdictions entered into the largest civil-litigation settlement agreement in U.S. history. State attorneys general had sued tobacco companies, arguing that the companies should take up the burden of paying for the costs of treating smoking-related diseases. In the settlement, which left the tobacco industry immune from future state and federal suits, the companies agreed to make annual payments to the states, in perpetuity, to fund public-health programs and anti-smoking campaigns.
 
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A.Goldberg

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of course the drug companies that allowed this to happen are immune.
Not exactly. Perdue Pharma has been sued for hundreds of millions and has some significant lawsuits against them in process. They of course ignited the opiate epidemic with their misadvertising of OxyContin.

Besides, the FDA actually imposes limits on manufacturing of narcotic medicines. But we all thought the FDA is supposed to promote drug safety... right?

I think the drug wholesalers are more responsible than the pharmaceutical companies. There aren't too many of them across the country. When you look at pill mill operations where hundreds of thousands of opiates were being ordered to individual pharmacies a year for years on end, well beyond any reasonable standard, you have to wonder why they haven't been held complicit.
 
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Herdfan

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of course the drug companies that allowed this to happen are immune.
How the hell would you hold the drug companies at fault?
Take a look at some of the statistics. The drug companies have shipped millions of opioid pills to towns with hundreds of residents. In Kermit, WV they shipped 9M pills to a town with 392 residents over a 2 year period. They know there is a problem yet they keep shipping pills and people keep dying.

There are several suits against the drug companies from KY, WV and OH.
 

Gutwrench

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Can we please stop this prescription opioid fixation? When I'm in pain I want my opioids and I don't want a doctor reluctant to give 'em to me.
 

Herdfan

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Can we please stop this prescription opioid fixation? When I'm in pain I want my opioids and I don't want a doctor reluctant to give 'em to me.
I agree. I am the same way when I have a bad cough. Give me the codeine with Phenergan not some stupid pearls.

But they have gotten way out of hand with pill mills that exist solely to prescribe opioids. I am not worried about an ER doc or you GP. They aren't the problem.
 

A.Goldberg

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Take a look at some of the statistics. The drug companies have shipped millions of opioid pills to towns with hundreds of residents. In Kermit, WV they shipped 9M pills to a town with 392 residents over a 2 year period. They know there is a problem yet they keep shipping pills and people keep dying.

There are several suits against the drug companies from KY, WV and OH.
More likely the wholesalers. Companies like McKesson, Cardinal, and Amerisource Bergen Corp- these 3 alone supply nearly 90% of pharmacies with drugs. Generic drugs typically aren't sent directly from the manufacturer. The wholesaler acts as an intermediary between the manufacturer and retail pharmacy. I'm sure about brand name opioids back in the day- certainly not recently. I doubt it based on their prevalence, direct from mfg shipping is usually only happens with rarely prescribed, expensive drugs.

It's not just people dying and lives and families being destroyed. Because of addiction unfortunately communities endure increased crime. Between 2006 and 2011 pharmacy robberies increased 80%+ nationwide. Last year California had a 71% increase in pharmacy robberies but thankfully overall crime is down 5% nationwide. When I was an intern I worked at a pharmacy that received a bomb threat, I showed up to meet a SWAT team. Around 2010 I experienced a home invasion at my parents house in a quaint town CT- I got a very good look at them and they had the appearance of opiate abusers- pale-unhealthy skin, sunken eyes, pinned pupils, etc. Of course there is more than just pharmacies getting robbed, there of course are people who steal and kill for drugs or money. And then you have healthcare workers, other strangers, friends, or family members who steal people's prescriptions directly, which in my mind stealing the property is minimal to stealing ones health and quality of life.

I am extremely sympathetic to addicts plight, I work with them daily. I understand the best I can as a non-addict to why they do what they do. That said, they still are responsible for the actions they take.

And that rant aside, the drug wholesalers have recieved relatively little penalty for their role in promoting opiate prescribing abuse. When a single pharmacy orders way more narcotics than most, they should be required to report that finding.
 

RootBeerMan

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Can we please stop this prescription opioid fixation? When I'm in pain I want my opioids and I don't want a doctor reluctant to give 'em to me.
^^This! After this operation how many legitimate doctors will be thinking twice about prescribing pain meds for their patients or will deliberately under prescribe to avoid the semblance of misconduct that could come down on them from some petty bureaucrat in the DEA? Pain management is hard enough, as it is and far too many in that area are scared out of their wits to prescribe the necessary amounts for people in serious pain. Add in the patients who have been imprisoned for taking pain meds and the DEA and Justice have been out of control on this issue for years. Addiction can always be addressed, but not at the expense of patients.
 
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Rhonindk

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More likely the wholesalers. Companies like McKesson, Cardinal, and Amerisource Bergen Corp- these 3 alone supply nearly 90% of pharmacies with drugs. Generic drugs typically aren't sent directly from the manufacturer. The wholesaler acts as an intermediary between the manufacturer and retail pharmacy. I'm sure about brand name opioids back in the day- certainly not recently. I doubt it based on their prevalence, direct from mfg shipping is usually only happens with rarely prescribed, expensive drugs.

It's not just people dying and lives and families being destroyed. Because of addiction unfortunately communities endure increased crime. Between 2006 and 2011 pharmacy robberies increased 80%+ nationwide. Last year California had a 71% increase in pharmacy robberies but thankfully overall crime is down 5% nationwide. When I was an intern I worked at a pharmacy that received a bomb threat, I showed up to meet a SWAT team. Around 2010 I experienced a home invasion at my parents house in a quaint town CT- I got a very good look at them and they had the appearance of opiate abusers- pale-unhealthy skin, sunken eyes, pinned pupils, etc. Of course there is more than just pharmacies getting robbed, there of course are people who steal and kill for drugs or money. And then you have healthcare workers, other strangers, friends, or family members who steal people's prescriptions directly, which in my mind stealing the property is minimal to stealing ones health and quality of life.

I am extremely sympathetic to addicts plight, I work with them daily. I understand the best I can as a non-addict to why they do what they do. That said, they still are responsible for the actions they take.

And that rant aside, the drug wholesalers have recieved relatively little penalty for their role in promoting opiate prescribing abuse. When a single pharmacy orders way more narcotics than most, they should be required to report that finding.
Do they act strictly as a distributor or do they handle the purchase orders? I've seen both for other Rx.
 

A.Goldberg

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Do they act strictly as a distributor or do they handle the purchase orders? I've seen both for other Rx.
I'm not exactly sure what you mean- usually the purchase orders are submitted through the wholesaler with independent pharmacies and small chains. Most pill mill activities happen with independent pharmacies due to the lack of corporate oversight.

Large chains like CVS and Walgreens have their own distribution divisions, though usually contract with a 3rd party for incidentals. For example CVS also uses Cardinal.

Interestingly, when you order narcotics only the pharmacist with power of attorney over the pharmacy has the authority to do so- at least in the states I've worked. Narcotic orders in addition to the wholesaler are submitted to the state's Drug Control authorities. So the state should know exactly what pharmacies are ordering. So they probably bear some responsibility too, assuming other states use similar methods.
 
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steve knight

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^^This! After this operation how many legitimate doctors will be thinking twice about prescribing pain meds for their patients or will deliberately under prescribe to avoid the semblance of misconduct that could come down on them from some petty bureaucrat in the DEA?
they should often doctors were careless prescribing these drugs.
 

A.Goldberg

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There really isn't much stopping doctors from prescribing opiates as they were for chronic pain patients. Some states have laws on acute pain cases. But other than that there have only been revised treatment "guidelines".

I think prescribers are weary of being liable for causing overdoses or promoting addiction. I think most prescribers don't really know much about drug abuse and addiction.

I am against widespread prescribing restrictions for chronic conditions, I think it will cause too many issues. The amount of opioid prescribing needs to be reeled in though- especially with minor surgeries and aches and pains. America prescribed more opiates than anyone in the world. In the 90's big pharma lobbied pain wasn't undertreated to promote the analgesic market. The truth is some pain is okay, especially in acute situations. Research has actually shown opiates to not always be most effective in chronic pain. Opioids really don't kill pain so much as they change your perception of pain as it is. There's a lot of other, alternatives out there too to avoid or reduce opioid use. Nonsteroidal antiinflamitory drugs (NSAIDs), steroids, ketamine and other NDMA antagonists, SSRI/SNRI/TCA antidepressants, antieileptics, nerveblocks/anesthetics, etc plus nonmedical treatments.

Let's take me as an example, I'm in my late 20's and have 3 herniated discs. I also have neuropathic pain as a result. I've been in chronic pain since I was in high school due to a sports injury. My doctors have made opioid painkillers available, but that's not a road I want to go down especially at a young age- especially considering side effects, tolerance and dependency issues. I swim daily, try to find the time to do yoga, have done acupuncture in the past, take ibuprofen + at times Gabapentin, and my pain at this point is generally at a tolerable level. I have a bottle of Vicodin for flare ups but take one maybe once a month at most. For most bad flare ups I prefer to get a Toradol shot which is an magical NSAID (like Advil or Aleve) that has the same painkilling effectiveness as morphine but no congnitive impairment, respiratory depression, or addiction/abuse risk (It does however pose renal risks so can only be given for 5 days in a row).

I have had autoimmune pancreatitis which is by far the most painful thing I have ever experienced. Thank god for for Dilauded (hydromorphone).
 

shinji

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Doctors who write way more opioid prescriptions than average for their specialty/location should be investigated ASAP. Same goes for anyone who writes those prescriptions for far more patients than they could legitimately be treating.

This story had a doctor's office with a standing room-only waiting room full of addicts, with a sign instructing them which pharmacy to go to. Very different than a bonafide pain management clinic.
 

Peterkro

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There really isn't much stopping doctors from prescribing opiates as they were for chronic pain patients. Some states have laws on acute pain cases. But other than that there have only been revised treatment "guidelines".

I think prescribers are weary of being liable for causing overdoses or promoting addiction. I think most prescribers don't really know much about drug abuse and addiction.

I am against widespread prescribing restrictions for chronic conditions, I think it will cause too many issues. The amount of opioid prescribing needs to be reeled in though- especially with minor surgeries and aches and pains. America prescribed more opiates than anyone in the world. In the 90's big pharma lobbied pain wasn't undertreated to promote the analgesic market. The truth is some pain is okay, especially in acute situations. Research has actually shown opiates to not always be most effective in chronic pain. Opioids really don't kill pain so much as they change your perception of pain as it is. There's a lot of other, alternatives out there too to avoid or reduce opioid use. Nonsteroidal antiinflamitory drugs (NSAIDs), steroids, ketamine and other NDMA antagonists, SSRI/SNRI/TCA antidepressants, antieileptics, nerveblocks/anesthetics, etc plus nonmedical treatments.

Let's take me as an example, I'm in my late 20's and have 3 herniated discs. I also have neuropathic pain as a result. I've been in chronic pain since I was in high school due to a sports injury. My doctors have made opioid painkillers available, but that's not a road I want to go down especially at a young age- especially considering side effects, tolerance and dependency issues. I swim daily, try to find the time to do yoga, have done acupuncture in the past, take ibuprofen + at times Gabapentin, and my pain at this point is generally at a tolerable level. I have a bottle of Vicodin for flare ups but take one maybe once a month at most. For most bad flare ups I prefer to get a Toradol shot which is an magical NSAID (like Advil or Aleve) that has the same painkilling effectiveness as morphine but no congnitive impairment, respiratory depression, or addiction/abuse risk (It does however pose renal risks so can only be given for 5 days in a row).

I have had autoimmune pancreatitis which is by far the most painful thing I have ever experienced. Thank god for for Dilauded (hydromorphone).
Maybe my experience might show how things work in the NHS.I'm fifteen days post op (Stoma reversal,parastoma hernia, it hurt like a mofo) after surgery I refused codeine as it messes my head up so they gave me a PCA (patient controlled analgesia) pump filled with Morphine,I also have a damaged liver so Morphine was a good choice.Four days post op the pump was removed (by agreement between me and registrar) no come down and I had two or three shots of oral Morphine for breakthrough pain and was discharged that night, enhanced recovery program,I have access to nurse specialists, registrar etc by phone if need be, one called eight days post op to see how I was doing.Everything appears to be working after a fashion and I'm quickly recovering.Two small wounds one has healed and the other because of weeping has been packed with a seaweed dressing that is changed every second day by the nurse at the local GP's. I have 100ml of oral Morphine solution sitting in a cabinet for breakthrough pain, haven't touched it and am three days free from other analgesics,Paracetamol,Ibuprofen.Seamless process so far.Why the NHS has relatively bad outcomes for some diseases is a bit of mystery.
This link is a bit of a fluff for the NHS but shows the difference in % of GDP and care levels etc.I won't sugar the pill the NHS is in crisis and it's caused by underfunding by a government which is ideology opposed to socialised medicine and sees the fourth biggest employer in the world as ripe for privatisation which will kill it stone dead and we'll revert to the idea of health care as seen in the US.
(by the way diamorphine is used in extremis for some patients)

https://www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey
 
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VulchR

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It's about time legal drug pushers in the US suffered some consequences of their actions. However, I'd rally like to see the companies that marketed the drugs as being safe be the focus of prosecutions, for they convinced physicians through some fairly dodgy practices that opiates were not likely to lead to addiction.

As for the continued use of opiates, they work effectively for some kinds of acute and chronic pain, and thus they should always be available. However, they have profound side effects and they really shouldn't be prescribed unless there is no other effective alternative. Certainly in these days of computers, the use of opiates should be tracked at all levels (patient, doctor's practice, and pharmacy).
 
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