Fraudulent Opioid Prescribers Can Expect More Federal Charges

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By James Swann

A surge in opioid-related settlements targeting individual physicians in 2018 is likely to continue as the government uses a law targeting false claims to fight the nationwide opioid abuse crisis.

The government recovered over $4.6 million from five individuals involved in opioid fraud in fiscal year 2018 under the False Claims Act, according to Bloomberg Law Data Analytics Manager Christina Brady and Analysis Manager Betsy Mountenay. Only two opioid-related FCA settlements with individuals occurred from 2014 through 2017.

“The government is targeting practitioners who are making money writing medically unnecessary opioid prescriptions and taking kickbacks from drug companies,” Mountenay said.

Brady added, “Although these settlements make up a small fraction of the government’s total recovery for 2018, they are large enough to send a warning to individual providers.”

Total FCA filings in cases involving opioid fraud among prescribers, drug companies, and addiction treatment centers also increased in FY 2018 compared to previous years, according to Brady and Mountenay.

“Providers prescribing and distributing opioids are on notice that their actions will be watched closely, and it’s essential that they remain up to date on current laws, monitor prescribing practices, and report any diversion promptly,” Anna Grizzle, a health-care fraud and compliance attorney with Bass, Berry and Sims Plc’s Nashville, Tenn., office, told Bloomberg Law.

Numbers Don’t Lie

The shift toward more individual opioid fraud enforcement can also be seen in data from the 2018 national health-care fraud takedown, an annual summer event in which the Justice Department unveils nationwide health-care fraud charges levied on a single day.

The June 2018 takedown showcased charges against 162 individuals for allegedly participating in schemes to fraudulently prescribe and distribute opioids, out of a total of charges filed against 601 people.

The initial 2010 takedown charged 94 people with health-care fraud, but didn’t include any opioid-related charges. It wasn’t until 2017 that opioid-related charges became part of the takedown, when 120 individuals were charged for opioid-related schemes out of charges filed overall against 412 individuals. The takedown is coordinated by the multi-agency Medicare Fraud Strike Forces.

FCA settlements have traditionally targeted companies, not individual doctors, and have largely steered clear of opioid fraud. The FCA imposes heavy financial penalties on companies or individuals who defraud the government.

Overall, the federal government recovered $2.5 billion from health-care related FCA settlements in FY 2018.

Settlements in which individuals were named increased three-fold, from 13 to 40, between FY 2016 and 2017, based on data collected by Bloomberg Law. This trend continued in 2018, when individuals were named in 46 settlements, including the five related to opioid fraud, Brady and Mountenay said.

Others Jumping In

The push for more FCA opioid fraud cases may be further boosted by several ongoing regional enforcement efforts, including the Appalachian Regional Prescription Opioid Strike Force, Antonio Pozos, a health-care attorney with Drinker Biddle & Reath LLP in Philadelphia, told Bloomberg Law.

The Appalachian Task Force was announced in October and includes representatives from the DOJ, the Federal Bureau of Investigation, the HHS Office of Inspector General, and the Drug Enforcement Administration.

The task force will go after opioid fraud in Ohio, Kentucky, West Virginia, Tennessee, and Alabama.

Grizzle also noted various states are joining in the anti-opioid fight and are imposing more stringent regulations and pursuing enforcement actions.

Request Health Care on Bloomberg Law