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Risk Fraud & Compliance

Holding Them Accountable: Targeting Opioid Manufacturers and Pill Mill Doctors in the Fight Against Healthcare Fraud

Melissa D. Berry  Lead Compliance Attorney Editor / Regulatory Intelligence / Thomson Reuters

· 5 minute read

Melissa D. Berry  Lead Compliance Attorney Editor / Regulatory Intelligence / Thomson Reuters

· 5 minute read

With the rising costs associated with healthcare fraud linked to the opioid epidemic, the federal government, along with states and local governments are fighting this battle on multiple fronts, implementing proven strategies to prevent, treat & combat the opioid problem and hold those who commit fraud accountable

It’s no secret that healthcare fraud is on the rise and the opioid epidemic is a major contributor. With the rising costs associated with this fraudulent behavior, governments and law enforcement are fighting the battle on multiple fronts.

Which is why it’s imperative that the federal government, states, and local governments promote and implement proven strategies to prevent, treat and combat the opioid health crisis.

As we have seen with the National Prescription Opioid Multidistrict Litigation (MDL) in Cleveland, consolidated, class action lawsuits are just one way this has worked. Some states are now taking matters into their own hands by filing separate lawsuits against the manufacturers and distributors of prescription opioids. Just as most cases in the MDL suit focus on key players in the opioid crisis, the state lawsuits allege that certain manufacturers and distributors are largely responsible for fueling the current opioid crisis.

But they aren’t the only targets. Some states are also zeroing in on doctors who operate what is known as a “pill mill,” a clinic in which doctors over-prescribe opioids for a profit. Below we will examine the different ways that governments are attempting to hold individuals and corporations responsible for their actions. We also will take a snapshot of some of the promising practices and policies that have the potential to curb the crisis.

Opioid Manufacturers and Distributors

Many of the state actions target Purdue Pharma, alleging deceptive marketing practices relating to the drug OxyContin. The deceptive practices include misrepresenting the risk of addiction from long-term use, claiming that long-term opioid use is safe and effective, and paying “key opinion leaders” to encourage opioid use.

Lawsuits filed against Purdue Pharma allege that the opioid crisis had resulted in death and injuries from overdoses and substantial costs to the states, including:

        • In Montana, more than 700 people have died from opioid overdoses and more than 7,000 people received emergency treatment;
        • In Florida, there 21,700 opioid-related emergency department visits in 2015 alone;
        • In Nevada, opioid-related hospitalization increased 136% from 2010 to 2016;
        • In New York, there were 2,399 opioid painkiller-related deaths; and
        • In Texas, there were 1,375 opioid-related deaths in 2016.

The states all allege that the cost of providing emergency services — police and healthcare, for example — are greatly increased as a direct result of the opioid crisis. And because many addicts are uninsured, the cost of their treatment often falls to the state Medicaid program.

Other states, like Ohio, are targeting major distributors, alleging these distributors were negligent and created a public nuisance by using unsafe practices and by irresponsibly oversupplying the market in and around Ohio with highly-addictive prescription opioids.

Ohio is seeking damages from McKesson, Cardinal Health, AmerisourceBergen, and Miami-Luken for costs relating to the state’s increased spending on healthcare, criminal justice, social services, and education.

In another coordinated action, seven states recently joined in a False Claims Act suit against Insys Therapeutics. In August 2018, North Carolina Attorney General Josh Stein announced he was filing suit against Insys by intervening in two lawsuits that accuse Insys of violating the False Claims Act. The suit echoed North Carolina’s previous allegations against Insys. According to the suit, North Carolina paid more than $4.8 million for prescriptions of Subsys, an Insys-made opioid oral spray, through the state’s Medicaid program.

The Attorneys General of California, Colorado, Indiana, Minnesota, New York, and Virginia also joined in the suit.

Pill Mill Enforcement

While states are seeking a way to cut of the supply from the top of the chain, the federal government continues to arrest and prosecute physicians and pill mills that provide patients with prescriptions for opioids that are not medically necessary and that then flood the country’s streets. Below are just a few examples of recent prosecutions:

Michigan and Ohio — The CEO of Tri-County Wellness Group — a network of pain clinics, labs, and other medical providers located in Michigan and Ohio — pleaded guilty on October 15, to a superseding indictment that involved an alleged $300-million healthcare fraud scheme that involved the distribution of more than 6.6 million dosage units of controlled substances and the administration of medically unnecessary injections that resulted in patient harm.

According to prosecutors, the CEO, Mahiyat Rashid, and the physicians working for him “allegedly flooded the streets with some 4.2 million” doses of drugs such as oxycodone, hydrocodone, and oxymorphone. Many of the prescriptions were written for Medicare patients.

Texas — A Houston physician, Gazelle Craig, DO, and the owner of a pain management clinic, Shane Faithful, were each sentenced to 420 months in prison on September 20, for “their roles in running a pill mill” that provided tens of thousands of unlawful prescriptions for millions of doses of opioids and other controlled substances.

Craig and Faithful, who ran Gulton Community Health Center, were convicted in a March trial of one count of conspiracy to unlawfully distribute controlled substances and three counts of unlawfully distributing and dispensing controlled substances. Evidence admitted at the trial showed that Craig unlawfully wrote approximately 18,252 prescriptions for more than 2.1 million dosage units of hydrocodone and approximately 15,649 prescriptions for more than 1.3 million dosage units of carisporodal, a combination of hydrocodone and carisoprodol with no known medical benefit.

North Carolina — Donovan Dave Dixon was sentenced to 240 months in prison on August 27 after being convicted of conspiracy to unlawfully distribute oxycodone and 20 counts of unlawful distribution of oxycodone. Dixon was a licensed medical doctor at the time of the offenses.

Evidence during his trial showed that Dixon prescribed “high-strength, high-dosage amounts of oxycodone with little or no medical examination.” Witnesses testified that Dixon had written hundreds of prescriptions in their names although they had never seen him. A local drug dealer testified that he provided names to Dixon, and then Dixon wrote prescriptions in those names in exchange for cash from the dealer. The dealer then sold the oxycodone on the streets of Robeson County, North Carolina.

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