health care fraud

Six medical providers made headlines weeks ago after they were indicted for illegally prescribing around 13.2 million doses of prescription for painkillers. In an indictment on December 6, the doctors from Michigan were charged with insurance fraud amounting to $464 million.

The court issued 56 counts of the indictment against the owner of the Pain Center USA in Eastpointe and Warren, Michigan and the Interventional Pain Center in Warren, Mich., 77-year-old Dr. Rajendra Bothra and five other doctors who work in the said clinic. The other doctors were Dr. Eric Backos, 65, Dr. Ganiu Edu, 50, Dr. David Lewis, 41, Dr. Christopher Russo, 50 and Dr. Ronald Kufner, 68.

It was reported that in order to take advantage of the opioid epidemic, the doctors billed insurance companies – Blue Cross Blue Shield, Medicaid and Medicare, with the maximum number of procedures and services they can without considering the needs of the patients. The prescriptions for pain medications included Percocet, Vicodin, OxyContin and Dilaudid.

The services that were allegedly performed by the doctors even when it was unnecessary included magnetic resonance imaging. In a statement issued on the day of the indictment, United States Attorney for the Eastern District of Michigan Matthew Schneider described the doctors who preyed on their patients to gain profit as “egregious.”

Rampant health care fraud

The almost $500 million-worth case of health care fraud was touted as one of the largest in the US. This is definitely not the first case of big-time health care fraud but it is, by far, the biggest case of involving the unnecessary prescription of painkillers as of December this year. In June this year, a health care CEO and four other doctors were also indicted for a $200 million health care fraud that involved harmful injections and unnecessary prescription of opioids such as hydrocodone, oxycodone and oxymorphone to beneficiaries of Medicare.

The superseding indictment of the case revealed the prescription of 4.2 million dosage units of opioids. The doctors involved were Mashiyat Rashid, Spilios Pappas, Tariq Omar, Joseph Betro and Mohammed Zahoor. According to the Office of the United States Attorney, Rashid was the CEO of the Tri-County Wellness as well as the owner and operator of several laboratories and pain clinics the areas of Michigan and Ohio.

The doctors named in the indictment allegedly required Medicare beneficiaries to undergo unnecessary and expensive injections. Likewise, those involved were also accused of performing the maximum number of injections that the insurance company paid for despite the dangers that it exposes the patients to. This case also happened in Michigan, a state which recorded 1,786 fatalities due to opioid overdose in 2016. The figure translates to five people who died due to opioid overdose every day.

In Hampshire, another medical professional was found guilty of eight counts of conspiracy and receiving kickbacks for prescribing a fentanyl spray called Subsys, a powerful opioid that is only meant for cancer patients to those who are experiencing back pains. The 44-year-old medical professional named Christopher Clough were said to have not warned patients about the dangers of getting addicted to the drug.

Are health care providers still reliable?

The most recent is highlighting the fact that even medical service providers who are supposed to care for patients are among those responsible for worsening the opioid crisis. Bothra, who operates the three clinics is apparently a renowned surgeon who even received the highest civilian honors in India in 1999. He was described as both a politician and a humanitarian for his efforts in raising awareness about AIDS and educating the public about the dangers of alcohol and tobacco. Unfortunately, Bothra’s team were also linked to luring patients and prescribing the maximum number of injections to patients.

This is the bigger problem that America is facing. Those who are supposedly helping patients to overcome addiction are becoming a part of the problem themselves. The unnecessary prescription of powerful opioids and injections aggravates the problem of addiction. People are getting hooked on the drugs with the help of their caregivers. Prescribed controlled substances even find their way out to the market and are sold illegally even to those who have no prescriptions.

‘Predators’ of the health care industry

Pain clinics like opioid rehabs are meant to alleviate the patients’ pain and help them recover from the illness, not to aggravate the problem. Director of research and network development of Boston Pain Care, Michael E. Schatman described the addiction treatment industry as becoming “predatory as a whole.” Patients who want to recover from addiction are slowly losing their options of where they can seek help.

It was only recently that Google resumed accepting rehab ads from addiction treatment facilities after the ban it implemented last year due to the proliferation of misleading and deceptive ads that use Google ranking to attract patients. Clicking through online ads is one of the resources that patients who need treatment rely on. Sadly, misleading advertisements that are flashed on Google pose risks to the patient’s health as they end up not getting the proper treatment.

These practices are not only unethical. They are dangerous and could be fatal to those who have severe substance use disorder. Government’s statistics on drug addiction shows alarming figures of over 115 people in the United States dying of opioid overdose daily. A year ago, 72,000 Americans died after a drug overdose and while the families of patients, health advocates, and other government and non-government agencies are working on ways to provide proper intervention to patients, there are wolves in sheep’s clothing lurking in the health care industry.

The national opioid crisis is causing problems on so many fronts and in complicated levels. One of the ways that we need in order to avoid overdose on opioid is to improve prescription, the question for the patients now is: Am I getting prescriptions from drug peddlers themselves? It is a real problem that needs an immediate action as the country continues to brace itself from the impact of what was described by Attorney General Jeff Sessions as the “deadliest drug crisis” in US history.

Adam Durnham is a freelance blogger that primarily writes about addiction, mental health, and law. He currently lives in Detroit, Michigan with his dog Beignet.

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