Unfortunately, this provider capitalized on his ability to prescribe controlled medications in other ways. By obtaining sexual favors from his patients, he was able to take advantage of his patients insatiable need for the drugs, and that the patient was willing to sell her body to support her drug needs. Overall, these types of cases can take many turns and twists, and it really is not just about some in the medical profession being a licensed drug dealer; the collateral effects are tremendous.
I had the unfortunate opportunity of working on an opioid prescribing matter where the patient (a Medicare beneficiary) was receiving several controlled substances, and ultimately overdosed and died. Prior to becoming addicted, she was a vibrant, young woman, who had injured her back pretty severely in a horseback riding accident. She was being treated by a doctor who was totally out of his element, and did nothing to actually work to treat her underlying problem.
She died with an empty pill bottle next her and a box of very potent narcotic patches. She paid a combination of cash and insurance for the drugs. The two major failures were:
- neither the doctor nor the pharmacist queried the Prescription Monitoring Program (PMP) database, and
- the state where this occurred did not do anything to corroborate the doctor’s CDS licensure renewal information (he marked that he had access to, and used the PDP, when neither were true).
There is a collateral third piece, which is that the state did nothing to data mine that this patient was paying both cash and insurance for these prescriptions each and every 30 days, like clockwork.
Although Operation Brace Yourself was a couple of years ago (when the “takedown” occurred), the cases and spin-off cases will be around for quite awhile. Whether its because of the cooperation of defendants, trials or delays from COVID, we will be seeing press for the future, no doubt. Again, using the “telemedicine” moniker, the fraud was able to be perpetuated through the use of telemarketing and providers being paid a per referral fee. Remember, it is not telemedicine fraud, it is “telemarketing” or “telefraud.”
On a bit of a lighter note, I’m excited for this. Jared Walker and Dollar For is very near and dear to me personally as well as to Jeanmarie Loria, MBA, PMP, CPC and Advize Having my fellow Chucklehead and dear friend sean weiss take an equal interest is exciting and hopefully motivating to those in our respective networks.