Attorney General Jeff Sessions has announced the formation of the Opioid Fraud and Abuse Detection Unit, a new Department of Justice pilot program that will focus on opioid-related healthcare fraud, using data to identify and prosecute individuals contributing to the prescription opioid epidemic.
Sessions made the announcement August 2 during a speech at the Columbus, Ohio, Police Academy.
“This sort of data analytics team can tell us important information about prescription opioids — like which physicians are writing opioid prescriptions at a rate that far exceeds their peers; how many of a doctor’s patients died within 60 days of an opioid prescription; the average age of the patients receiving these prescriptions; pharmacies that are dispensing disproportionately large amounts of opioids; and regional hot spots for opioid issues,” said Sessions.
As part of the program, the Department of Justice will fund 12 experienced Assistant US Attorneys for a 3-year term to uncover fraud related to prescription opioids, including pill mill schemes and pharmacies that unlawfully divert or dispense prescription opioids for illegitimate purposes. The following districts have been selected to participate in the program:
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Middle District of Florida,
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Eastern District of Michigan,
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Northern District of Alabama,
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Eastern District of Tennessee,
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District of Nevada,
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Eastern District of Kentucky,
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District of Maryland,
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Western District of Pennsylvania,
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Southern District of Ohio,
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Eastern District of California,
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Middle District of North Carolina, and
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Southern District of West Virginia.
These are locations around the country “where we know enforcement will make a difference in turning the tide on this epidemic,” said Sessions.
The prosecutors will work with the Federal Bureau of Investigation, the Drug Enforcement Agency, and the US Department of Health and Human Services, as well as state and local partners, to help “target and prosecute these doctors, pharmacies, and medical providers who are furthering this epidemic to line their pockets,” Sessions said.
“With these new resources, we will be better positioned to identify, prosecute, and convict some of the individuals contributing to these tens of thousands of deaths a year. The Department is determined to attack this opioid epidemic, and I believe these resources will make a difference,” he added.
In 2015, more than 52,000 Americans died of a drug overdose, Sessions noted, and preliminary data for 2016 suggest that nearly 60,000 Americans lost their lives to drug overdoses. “That will be the highest drug death toll and the fastest increase in that death toll in American history. This is not a sustainable trend nor an acceptable America,” Sessions said.
Commenting on the newly created opioid fraud and abuse detection unit for Medscape Medical News, Steven P. Stanos, DO, president of the American Academy of Pain Medicine, said the academy understands and applauds the attorney general’s concerns about addressing fraud and abuse within the healthcare system.
“To the extent that his efforts are focused on catching up with pill mills, other illegal criminal-based medical practices, and clinicians who are gaming the system in any way, we support his efforts whole-heartedly. But we need to be sure that legitimate prescribing of opioid analgesics by physicians as part of a patient’s individualized treatment program is not inadvertently caught up in the net of law enforcement. Therefore, it is critical that the criteria for identifying criminal activity be clearly established and that it not rely simply on such data points as the number of prescriptions written or doses prescribed.”
For example, said Dr Stanos, in the state of Washington, where he practices, the law stipulates that patients being prescribed more than 120 mg morphine equivalent should be referred to a pain specialist for a consultation.
“Additionally, pain management specialists inherently manage a proportionately greater number of patients on opioid therapy than other providers and help care for patients with comorbid psychiatric conditions and other complex medical problems. It’s very likely that these pain specialists could be swept up in the fraud and abuse detection efforts if monitoring efforts and data collection are not accurate or incomplete,” he said.
“The [American Academy of Pain Medicine] supports the use of evidence-based guidelines to help better manage and safely care for patients with chronic pain, including many individual state guidelines as well as the recent [Centers for Disease Control and Prevention] guideline for opioid prescribing in primary care,” he added.
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