Throughout the year, the Office of Inspector General (OIG), as well as the Department of Justice (DOJ) and President Trump, have made it clear that opioid abuse is a primary area of focus for government agencies. In a recent announcement, Attorney General Sessions showed that the government isn’t just talking- they are taking action. On August 2nd, Attorney General Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit. This new unit of the DOJ will be a pilot program to utilize data to help combat the opioid crisis.
Recently, the state of New Jersey ramped up its enforcement efforts by sanctioning 31 physicians for allegedly over-prescribing painkillers. This is a trend that seems to put a dent in the proliferation of addiction to pain killers, and the epidemic of pain killer narcotic over-prescription.
When you are a pharmacist you are reponsible for administering drugs in a lawful and compliant manner. Logic tells you dispensing drugs to living persons is a starting point. However, one pharmacy recently found out what the repercussions were of administering drugs to "dead people." The owners of an independent pharmacy specializing in HIV and AIDS related medication agreed to pay the U.S. Government $7.8M to settle claims of overbilling CMS, which included dispensing medicine in the names of patients who have died. The settlement is to be paid in a duration of 5 years as the company makes money. A whistleblower brought the claim through aqui tam action alleging False Claims violations.
Seems like a simple question. But the answer may surprise you. There are three things that are needed for a referral to be legitimate and to avoid potential civil fines, penalties and OIG exclusions. 1. Does the Physician have a current license without restrictions? 2. Is the Physician privileged or credentialed at the hospital? 3. Is the Physician excluded from participating in Medicare/Medicaid or other federal health care dollar reimbursed programs?