Medical Providers Beware. Because of the opioid crisis across the United States, there is a heightened scrutiny of medical providers associated with prescribing opiate medications. Thousands are dying every year due to opioid overdoses. According to the American Society of Addiction Medicine in 2016 there were 20,101 deaths caused by overdoses on prescription opioid medication. Law enforcement has taken notice that the prescription opioid crisis is very real and causing serious harm to individuals and families nationwide, and prosecutors want to be part of a solution.
Accordingly, State and Federal governments are combating the problem with criminal investigations of medical providers, but too often their tactics and their targets are inappropriate. Medical professionals involved in pain management do their jobs with the goal of helping patients lead better lives. Because they’re in a profession that oversees opioids, they usually have targets on their backs. As a result, physicians and the doctor’s clinics and staff are finding themselves the subjects of investigation and prosecution for:
for treating their patients with pain management.
To avoid investigation, be sure that each time opioids are prescribed, the medical provider sees the patient in person, does blood work, documents the file with results, personally signs the orders and prescriptions, checks the patient’s PMP file to determine if the patient is seeing other physicians or getting meds elsewhere, and any document any other procedure used by your office. Also, be sure that staff are properly educated concerning the medical protocols and billing requirements. Although staff may prepare the Medicaid claim forms, it is the provider who is at risk if there are systemic errors.
Federal and state governments have both cracked down on the prescription of opioid medications. They target health care professionals including doctors, pharmacists, and others who help patients manage pain. Their goal is to reduce the number of available opioid pills by targeting alleged “pill mills”–organizations and individuals that prescribe opioids when they aren’t medically necessary or that prescribe opioids outside of a professional standard of care. The government is targeting both doctors and clinics believed to be putting profits before their patients’ well-being.
Those involved in pain management understand the risks of their profession. However, sometimes a clinic or a physician’s processes and screening don’t catch patients who are pill seekers. Patients may shop around for doctors who will give them pain medication, and if a doctor prescribes medication to a pill seeker, the doctor or clinic may be the ones ultimately charged.
The people targeted by the government may be completely innocent. Circumstances around a pain management professional’s practice may give the appearance of illegality or impropriety when in fact the prescription patterns are legitimate efforts to reduce patient pain and increase the quality of life for the patient. Thus, record-keeping protocols must be created and followed.
Most decisions to investigate medical providers and organizations are based on automated prescription data (the PMP database). Automatic systems analyze the amount and frequency of opioid prescriptions and automatically flag prescribers with unusual patterns. The trouble is that many times, legal and ethical prescription patterns are flagged and often lead to an investigation and possible criminal charges or medical board sanctions.
According to the Justice Department, there are patterns that may be flagged by the authorities:
An investigation may also begin as the result of routine audits, or if the authorities receive information that raises a suspicion. Unfortunately, routine audits may rely on faulty data or errors in claims submissions. Tips from patients and others may come from problem patients who are trying to cause trouble for the doctor or organization. Once the investigation starts, it can be very slow to stop. At that point you need counsel. You need a lawyer experienced in Medicaid and Pill Mill investigations.
Once an physician or medical group or practice is flagged, authorities will conduct a deeper investigation and potentially send undercover agents to obtain opioids from the prescribing medical provider. These undercover agents may engage in legally and ethically questionable tactics to bribe and harass staff into giving them the pain medication sought. At the end of the investigation, the authorities may raid the facility causing substantial professional harm and injury to reputation. Records of all patients and the provider’s computer systems often will be seized – leaving a medical provider in a predicament when providing future services to patients.
If you’re facing a criminal investigation or have already been charged, speak with an attorney as soon as possible. The sooner an attorney is protecting you and your rights, the better your chances of avoiding penalties, whether criminal or medical license-related or threats of being barred or banned from Medicaid or Medicare.
The criminal charges filed against you will depend upon the facts of your case and might include:
The government may bring these any many other charges against you. If you’re convicted, the penalties for these crimes may be severe. Punishment can include jail or prison time, huge fines, and seizure of your assets. You may also face professional sanctions, loss of your medical licenses and privileges, exclusion from Medicaid or Medicare and other complications.
Merely the damage to your reputation can be devastating. So you face any type of criminal, civil or administrative investigation the State or the Feds, get the representation you need now. A lawyer can help you defend yourself against the charges and protect your professional reputation.
Medical providers (doctors, physician’s assistants, and clinics) must have a strong paper trail in the event of an investigation. If contacted by the OIG (Office of Inspector General), the FBI, the Oklahoma Attorney General, or any other law enforcement or even the State Board of Medical Licensure or the Board of Osteopathy, DO NOT give any statements or provide patient files (without a subpoena or search warrant).
Take the investigator’s card and tell them you will have your lawyer contact the officer.
When you are accused, it’s critical to have quality representation at every step in the process. At the Wyatt Law Office, we are committed to defending healthcare professionals who have been charged with crimes involving opioids. We understand how serious these charges are, and we understand how a charge can damage your life. Your practice and your reputation can all come under a shadow when you’re targeted by the government.
When you’re facing accusations, we will:
At the Wyatt Law Office, you will get experienced criminal lawyers. Our lawyers focus solely on criminal defense law and have years of experience representing those accused of crimes including Medicare and Medicaid Fraud and other types of white-collar and non-white collar cases. He has been named in The Best Lawyers in America, and Best Lawyers has recognized him as “Lawyer of the Year” in Oklahoma City for criminal defense on multiple occasions.