August 4, 2017 - Posts

America’s Opioid Crisis: Human Tragedy and Major Source of Medicare Fraud

America’s opioid crisis has been in the news a lot recently, and for good reason.  According to data from the Centers for Disease Control, there were more than 33,000 opioid related deaths in 2015, nearly half of which were linked to prescription opioids.  Stories of individual lives and entire communities shattered by opioids are everywhere, as are stories of “pill mills,” facilities where doctors routinely write prescriptions for heavy duty painkillers such as oxycodone, hydrocodone, and tramadol, with no real regard for medical necessity.


What has not been covered to nearly the same extent is that America’s taxpayers are footing the bill for a huge number of these questionable prescriptions.  Accordingly to a recently released study from the Office of the Inspector General for the Department of Health and Human Services (“HHS OIG”), one out of every three Medicare Part D beneficiaries (a total of 14.4 million people) received at least 1 prescription opioid drug in 2016, and Medicare paid a total of $4.1 billion dollars for these prescriptions.


The majority of these prescriptions are legitimate and medically reasonable.  But that still leaves millions of questionable or outright fraudulent prescriptions being paid for with federal dollars.  HHS OIG has identified 501,008 beneficiaries who received high amounts of opioids in 2016, and almost 90,000 beneficiaries who either received “extreme” amounts of opioids or appeared to be doctor shopping, or both.  HHS OIG has also identified 401 prescribers with questionable opioid prescribing patterns—i.e. doctors and other health care providers who wrote significant numbers of prescriptions for significant numbers of at risk beneficiaries.


In light of our nationwide opioid crisis, federal and state law enforcement have made it a priority to shut these pill mills down, and private whistleblowers have a major role to play in that effort.  Ethical providers and administrators often find themselves working in unethical practices, looking for ways to speak up and do the right thing.  The federal False Claims Act provides one such avenue, allowing those employees to come forward with their first-hand knowledge and file a lawsuit on behalf of the United States for these false and fraudulent claims for payment.


These False Claims Act lawsuits are of vital importance to the U.S. Government and to society at large, as these whistleblowers often possess first-hand knowledge that the government would never otherwise learn about.


To read HHS OIG’s full report on questionable prescribing of opioids within the Medicare Part D program, see the link below.


Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing


To learn more about our Whistleblower & Qui Tam practice click here.  Our firm is located in Nashville, Tennessee but we represent whistleblowers all around the country.

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