The Dreaded HHS Drug Utilization Review Board Letter Regarding Morphine Equivalents: What Does It Mean?

The Michigan Health and Human Services Drug Utilization Review Board (DUR) has been sending letters to physicians who they believe are “high-volume opioid prescribers.” This letter can be quite alarming for a physician. But what does it mean?

As a background, the DUR monitors the safety of medication use and prescribing trends within the Michigan Medicaid population. It also analyzes Medicaid claims to determine how your statistical prescribing habits measure up with the average Medicaid prescriber.

Receiving the high-volume opioid prescribers letter from the DUR simply means you may have been “red flagged” as a physician potentially engaging in prescribing without medical necessity or Medicaid fraud or Medicare fraud. Essentially, your morphine equivalent daily dose (MEDD) is higher than the DUR’s statistical average, and that prompted the letter.

There may be an innocent explanation for this, and it is important to note that the DUR does not use geographic region, scope of your practice, and the medical needs of your patients when determining whether or not you statically deviate from other prescribers. However, regardless of the reason for the statistical deviation, it is highly likely that the Department of Health and Human Services and the medical board will consider investigating your practice.

That’s why it’s vital that you immediately contact an experienced healthcare law attorney to discuss your prescribing habits, and, potentially, conduct an audit to prevent or mitigate the potential for a DEA, HHS or DOJ investigation into your practice.