A thorough and well-understood compliance program for health providers and healthcare entities is needed now more than ever. Recently, the Justice Department’s Criminal Division created the Appalachian Regional Prescription Opioid (ARPO) Strike Force to focus on illegal opioid prescriptions. Just recently, ARPO federal prosecutor charged over 60 physicians and pharmacists for illegally prescribing opioids to patients that didn’t require them, making it the largest crackdown of its kind.
In the region, as many as 32 million illegal prescription pain pills have been distributed to patients over the course of the investigation, prosecutors refer to the providers as “white-coated drug dealers”.
The task force is spread out over 5 states in Appalachia including Ohio, Kentucky, Tennessee, West Virginia, and Alabama. ARPO has two methods for catching pill mill operations. Investigators track prescription data monitoring programs and Medicaid billing to identify who prescribes abnormally high amounts of pain medications. From this point, investigators send in undercover agents, perform raids, and charge providers.
This task force is a joint law enforcement effort that will bring a variety of resources and expertise together to fight the overprescribing crisis, including the Health Care Fraud Unit in the Criminal Division’s Fraud Section (HCF Unit), the U.S. Attorney’s Offices in nine federal districts and five different states, the FBI, U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), and the U.S. Drug Enforcement Administration (DEA). For the full article Click Here.
The task forces are specifically looking for fraud relating to suboxone prescribing, methadone prescribing, DATA waiver prescribing fraud, OTP (opioid treatment program) prescribing, and NTP (narcotic treatment program) prescribing. There is a strong crackdown on these areas – many providers are getting complaints or are being accused of over-prescribing and facing investigations.
The overall mission of the ARPO Strike Force and the Medicare Fraud Strike Force is to investigate health care fraud schemes in the region and surrounding areas. With many resources available and a goal to crack down on over-prescribing, it is likely that many providers will be targeted. If a healthcare entity is to be proactive, it is critical they develop and maintain a company compliance program containing policies and procedures.
If you have a compliance program that pre-dates the investigation, the government will take that into consideration before issuing fines and criminal charges. A compliance program will reduce your culpability score and, in many cases, prevent such incidents from happening. Complying and self-reporting will help employees identify and prevent these issues before they develop into allegations and complaints.
Some healthcare entity compliance programs do not consider the full scope of investigations and often are not enforced or well understood. If you are facing over-prescribing allegations or are concerned about your current compliance program, call Chapman Law Group today for a consultation.
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