The City of Delray Beach, Florida, is considering requiring pain management patients to give their fingerprints so those fingerprints can be used to immediately electronically check against a database to make sure the patient is not doctor shopping. That sounds great, but there is currently no electronic patient fingerprint network or database anywhere and for Delray Beach to create and maintain one itself it would cost more than they likely have budgeted for much of the services the city provides.
To read more, click here.
One bill pending before the Florida legislature proposes requiring that all physicians issuing a prescription for Schedule II and III controlled substances use a “multi-state electronic prescribing network” to verify whether a patient is doctor shopping. Unfortunately, no such network exists for controlled substances. In addition, the statute does not provide any way to fund it except for grants from unknown sources. For more, click here.
Monthly Archives: February 2010
Undercover Patients for Medicare Fraud Investigations?
U.S. Senator Tom Coburn of Oklahoma, who is also a medical doctor, is proposing that the United States root out Medicare Fraud through the use of undercover patients. Actually this is not new a new idea, government agents have in the past used undercover activities for precisely this purpose; recently, undercover agents posing as patients have been used extensively for investigations of pain management clinics.
Part of the problem is that often the undercover agent has to come up with a malady that would be the pretense of the visit. Generally, undercover agents posing as patients generate a false identity as well as a false medical history; sometimes going as far as to use test results, x-rays or the like from other, real patients. Sometimes, for example with pain clinics, the condition could be somewhat subjective; “My back hurts.” Such investigations can have good, bad and sometimes even funny results. In one undercover investigation, a Medicaid fraud agent, posing as a patient going to physician’s offices where it was alleged patients were paid, learned that one of the physicians he went to see diagnosed him with, among other things, erectile dysfunction. On the not so funny side, one department of insurance agent investigating chiropractors posed as a patient and wound up receiving an adjustment that injured his back.
In the Medicare arena, since the program is for persons over 65, the challenge would be to use retired or near retired agents and then address the same quandary; do you falsify conditions or symptoms? This can be more difficult to do with an older agent/patient; some conditions or diagnoses that might lend to potential fraudulent activity by physicians such as cancer and cardiac conditions are difficult to fake. Although scenarios can always be found to avoid a circumstance where a patient will receive certain treatments or injections, sometimes the outcomes are hard to determine.
To read more, click here.
Create A Problem to Solve A Problem; An Internet Canadian Pharmacy Originator Loses His License
In case where it appears the governments of the Untied States and Canada to stop a practice they disfavored, created a worse problem, the originator of the Canadian internet pharmacy business model gave up his license to practice pharmacy in Manitoba, Canada after it was alleged he had been selling misbranded and counterfeit prescription drugs. The story is somewhat more complicated than that.
Prior to the passage of the Medicare Part D prescription drug act, the purchase of name brand prescription drugs from Canada was becoming a significant business. Canada has price controls on prescription drugs and a name brand medication can be purchased in Canada for a significant discount over those purchased in the United States. Seniors and uninsureds looking for cheaper drugs found access to Canadian drugs either through storefront brokers in the United States or over the internet. However, since Canadian pharmacies could not accept US physician prescriptions directly, Canadian internet pharmacies came up with a system whereby a US citizen would fax their prescription to the pharmacy, a Canadian physician working with the pharmacy would write a prescription for the same drug and the Canadian pharmacy would fill it.
One of the originators of the internet Canadian pharmacy business was Andrew Strempler, who created Mediplan Pharmacy in Canada to service US customers and Mediplan did very well for a while. However, the FDA alleged that since the drugs did not come through the US system, the purchases were unlawful and moved with varying success against the US based companies involved in the business but were unable to move against the Canadian pharmacies that were following Canadian law.
However, the industry in the US and Canada was dealt more severe blows by Medicare Part D, which took away a large part of the seniors market. Also, the Canadian government, feeling pressure from manufacturers, enabled Canadian branches of US manufacturers to place limits on the number of name brand drugs a Canadian pharmacy could order and receive. To get around these limitations, it was alleged that Mediplan and other pharmacies began dispensing prescription drugs purchased from countries outside of Canada to get around the limits the Canadian government and manufacturers placed on purchases. The FDA seized several shipments form Mediplan to US customers and alleged the drugs shipped were not Canadian drugs, but were drugs purchased from 27 different countries and were therefore misbranded and counterfeit.
While the FDA claimed this proved they were right all along about the purported safety of Canadian pharmacy purchases, the system actually was much safer before the manufacturers, US and Canadian government got involved to try and solve a problem, drug safety, they wound up creating.
To read more, click: here.
Man Sentenced To 70 Months In Drug Diversion Scheme
Arnesto Segredo, of Miami was sentenced to 70 months in prison for of conspiring to divert the prescription drugs Serostim and Nutropin AQ. Both drugs are human growth hormones (HGH).
The scheme involved Segredo using first and unlicensed company and then a Florida licensed wholesale company to buy and then resell the drugs that were originally purchased by co-conspirators in California from AIDS patients who were prescribed the drugs which were paid for by the California Medicaid program. The use of HGH by AIDS patients is used to prevent what is called “wasting” or the deterioration of muscle. The drugs are also used on the illegal market, by body builders to bulk up muscle mass.
Mr. Segredo wad convicted by a federal jury after going to trial. Going to trial was a pretty brave act given that the prosecutor’s opening statement to the jury likely contained some form of the following: Desperate, poor, dying people sold away the drugs that helped keep them alive so Mr. Segredo could make a profit; oh, and by the way, Medi-Cal paid for those life saving drugs so Mr. Segredo’s lucre also came at the expense of the hard-working taxpayers of California and the United States.
To read more, click: here.
Google Gets Around To Policing Internet Pharmacy Sites
Google has for many years profited somewhat well from advertising by websites dedicated to gambling and internet pharmacy. Website owners who want to advertise on Google and other search engine companies bid on words in an ongoing auction. So, when a person enters a search term and advertisements pop up on the screen top and sides, it costs those advertisers money for the placement and for the number of clicks on those advertisements. Some of the highest cost adwords are for gambling and prescription drugs. Google has long had a strange relationship in that regard with their most profitable advertisers, at times being accused of enabling illegal conduct.
Google has taken steps over time to try to distance itself from some of those advertisers. Two years ago the United States passed the Ryan Haight Act to attempt to eliminate so called rogue internet pharmacies that provided prescription drugs without physician face to face interaction. Google had sought to limit the number of such pharmacies advertising on its search engine but there are still many that operate and advertise. In what seems to have been a long time coming, Google has now instituted a policy that requires any pharmacy related websites in the United Sates to be certified by the National Association of Boards of Pharmacies through its VIPPS program and for Canadian pharmacy websites to be certified by the Canadian International Pharmacy Association (CIPA.). The policy also prevents Canadian pharmacies from advertising in the United States.
For more click here.