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Date: April 29, 2024 Mon
Time: 11:57 pm
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Results for prescription fraud
13 results foundAuthor: Rodwell, Laura Title: What Do Police Data Tell Us About Criminal Methods of Obtaining Prescription Drugs? Summary: Recent reports suggest that the illicit use of prescription medicines, particularly pharmaceutical opioids is increasing in Australia. The aim of this study was to use police data to examine: (1) whether this increase is reflected in police crime data; (b) some of the criminal methods by which these medicines are obtained; and (c) which particular medicines have been most commonly sought through these methods over time. Details: Sydney: NSW Bureau of Crime Statistics and Research, 2010. 12p. Source: Internet Resource; Crime and Justice Bulletin, No. 139 Year: 2010 Country: Australia URL: Shelf Number: 118722 Keywords: Drug Abuse and AddictionOpioidsPrescription FraudPrescription Medicines |
Author: U.S. Department of Justice. Drug Enforcement Administration. National Drug Intelligence Center Title: National Prescription Drug Threat Assessment Summary: This assessment focuses primarily on domestic diversion of controlled prescription drugs (CPDs). It examines current nonmedical use of prescription-type psychotherapeutic drugs (opioid pain relievers, tranquilizers, sedatives, or stimulants) and discusses their distribution, and societal impact of CPD diversion and abuse, and Prescription Drug Monitoring Programs that have been established legislatively in many states to stem CPD diversion and abuse. This assessment also examines regional deviations from national trends. Details: Johnstown, PA: National Drug Intelligence Center, 2009. 62p. Source: Internet Resource Year: 2009 Country: United States URL: Shelf Number: 118769 Keywords: Drug Abuse and AddictionOpiodsPrescription DrugsPrescription Fraud |
Author: Blumenschein, Karen Title: Independent Evaluation of the Impact and Effectiveness of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER) Summary: The abuse and diversion of controlled prescription drugs is a significant and persistent problem in the United States. Current data from the Substance Abuse and Mental Health Services Administration (SAMHSA) 2007 National Survey on Drug Use and Health reveals that approximately 6.9 million individuals aged 12 or older are nonmedical users of controlled prescription drugs (opioid pain relievers, tranquilizers, sedatives, or stimulants). While the number of non-medical users has remained relatively stable over the past 5 years, the number of treatment admissions and deaths from overdose of controlled prescription drugs has increased significantly. To begin to address prescription drug abuse in the Commonwealth, on July 15, 1998 the Kentucky Legislature mandated the establishment of an electronic system for monitoring controlled substances (CS) through passage of Kentucky Revised Statute (KRS) 218A.202. The Kentucky All Schedule Prescription Electronic Reporting Program (KASPER) was thus designed. The rules for reporting and access were defined in Kentucky Administrative Regulations (902 KAR 55:110) promulgated on December 16, 1998. Data collection from dispensers of CS was initiated on January 1, 1999. The original version of KASPER required dispensers of CS in Kentucky to report dispensing of Schedule II, III, IV and V CS every 16 days. Significant enhancement of KASPER occurred in 2004 with creation of eKASPER. As described in a comprehensive report on Kentucky’s prescription monitoring program prepared by the Cabinet for Health and Family Services (CHFS) in 2006, the vision for eKASPER was “to create a system to allow authorized users to request a report through the Internet 24 hours per day, 7 days per week, and to receive the report in real time (within 15 minutes of request) while continuing to allow them to request reports through the mail or by fax.” The eKASPER system was launched on March 16, 2005 and has been recognized at the state and federal levels as a model program. Additionally, as a result of regulatory amendments to 902 KAR 55:110, dispensers of CS are now required to report dispensing records to KASPER every 7 days. Although satisfaction surveys of KASPER users, including pharmacists, prescribers and law enforcement officials, were conducted in 2004 and 2006, an independent evaluation of the impact and effectiveness of KASPER has not been conducted. This report presents such an evaluation. Details: Lexington, KY: Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, 2010. 81p. Source: Internet Resource: Accessed May 23, 2011 at: http://chfs.ky.gov/NR/rdonlyres/24493B2E-B1A1-4399-89AD-1625953BAD43/0/KASPEREvaluationFinalReport10152010.pdf Year: 2010 Country: United States URL: http://chfs.ky.gov/NR/rdonlyres/24493B2E-B1A1-4399-89AD-1625953BAD43/0/KASPEREvaluationFinalReport10152010.pdf Shelf Number: 121785 Keywords: DrugsPrescription Drug Abuse (Kentucky)Prescription Fraud |
Author: Bradford, Deborah Title: Modelling Supply Rates of High-Strength Oxycodone Across New South Wales Summary: The objective of this research was to develop a statistical methodology for identifying areas with aberrantly high supply levels of 80mg oxycodone controlled-release (CR) tablets, a prescription medicine that is currently a target for illicit diversion in Australia. The intention in developing this methodology was to provide assistance to the Pharmaceutical Services unit of the New South Wales Department of Health in monitoring supply and prescribing of high-strength prescription opioids. Statistical analysis focused on modelling variations across New South Wales (from 2006 to 2009) in wholesale supply rates of 80mg oxycodone CR tablets while controlling for relevant demographic and public health characteristics of each area. This analysis identified a number of Local Government Areas with supply levels of 80mg oxycodone CR tablets that were significantly higher than that predicted by the statistical model. In contrast to analysis of raw unadjusted supply counts of this medicine, which were highest in areas with large populations, statistical modelling identified mainly regional areas as those with unexpectedly high supply rates of 80mg oxycodone CR tablets. The current findings highlight the importance of controlling for relevant population level characteristics related to indications for opioid prescribing when evaluating trends in supply of these medicines. Details: Sydney: NSW Bureau of Crime Statistics and Research, 2011. 12p. Source: Internet Resource: Contemporary Issues in Crime and Justice, No. 148: Accessed June 30, 2011 at: http://www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB148.pdf/$file/CJB148.pdf Year: 2011 Country: Australia URL: http://www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB148.pdf/$file/CJB148.pdf Shelf Number: 121929 Keywords: Drug Abuse and AddictionOpioidsPrescription Drugs (Australia)Prescription Fraud |
Author: Virginia Department of Health Professions and Virginia State Police Title: Prescription Monitoring Program Summary: Chapter 481 of the 2002 Acts of Assembly amended the Code of Virginia to create a prescription monitoring program as a pilot program limited to State Health Planning Region III in Southwest Virginia. The program began operations in September 2003 with prescriptions dispensed for Schedule II controlled substances being submitted by approximately 300 pharmacies and other dispensers twice a month. Currently, the database contains over 460,000 prescription records and over 1000 requests for information from the program have been processed. Review of data collected thus far appears to show that the implementation of the program has not had a “chilling” effect on the legitimate prescribing of Schedule II controlled substances. The amount of oxycodone and hydrocodone being distributed in wholesale distribution channels continued to increase throughout Virginia at a rate of 9% and 8% respectively in 2002 and 2003. Information maintained by the Department of Medical Assistance Services (DMAS) shows that after a substantial drop in claims for oxycodone containing prescriptions in the 1st and 2nd quarters of 2002, the number of claims submitted in the 1st quarter of 2004 for these products are 21% higher than they were in the 1st quarter of 2001. A survey was conducted in mid-2004 and compiled by the Survey and Evaluation Research Laboratory, Virginia Commonwealth University and sponsored by the American Cancer Society (ACS) and the South Atlantic chapter of the ACS, in collaboration with the Virginia Cancer Pain Initiative. Physicians were asked if in the past three years, they have been prescribing fewer Schedule II controlled substances. 36% of respondents reported prescribing fewer Schedule II drugs; of these, 48% cited intense media coverage and 41% cited increased law enforcement activity as the reason for prescribing fewer Schedule II prescriptions. 31% of these practitioners reported that prescribing fewer Schedule II drugs had a negative impact of helping patients manage their pain while 61% reported no impact. A concern of having a pilot program in only the southwest portion of the Commonwealth was that the illegal activity of prescription drug diversion would move to outside the program area. Data from the Drug Diversion Unit of the State Police appears to confirm that concern. Data comparing 2003 to 2004 shows complaints received by the unit increased by 26% statewide while decreasing in the program area by 47%. Arrests increased by 35% statewide versus 31% in the program area. It also appears that using the program may save substantial man-hours in performing investigations with data from the program area showing a 53% decrease in manhours spent doing pharmacy profiles between 2003 and 2004. Accidental deaths due to prescription drug abuse or misuse continues to be a significant public health concern in Virginia, especially the southwest region of the Commonwealth. Since 2000, there has been a 100% increase in drug deaths in the Western District of the Office of the Chief Medical Examiner. Statewide in 2003, there were 223 drug deaths reported in the Western District, 101 in the Tidewater District, 106 in the Central District and 108 in the Northern District. In the Western District, 44.6% of the cases identified methadone as the cause of death followed by hydrocodone, oxycodone, fentanyl and propoxyphene. The issue of prescription drug abuse is not limited to Virginia. The President’s 2004 National Drug Control Strategy highlighted the problem, reporting that the non-medical use of addictive prescription drugs has been increasing throughout the United States at alarming rates. According to the National Survey on Drug Use and Health, in 2002, an estimated 6.2 million Americans reported past-month use of prescription drugs for non-medical purposes. Nearly 14 percent of youth between the ages of 12 and 17 have used such drugs, which include pain relievers, sedatives/tranquilizers, or stimulants, for non-medical purposes at some point in their lives. To combat this problem several approaches are being developed, including education and training on appropriate pain management and opioid treatment procedures for practitioners, increasing the number of state prescription monitoring programs, and using technology to identify, investigate, and prosecute “pill mills” including internet pharmacies that provide controlled substances illegally. In May 2004, Department staff developed a list of policy issues that became evident as a result of the evaluation workplan. These policy issues were reviewed at the June and September 2004 meetings of the Advisory Committee and recommendations were made based on those issues. Details: Richmond, VA: Virginia Department of Health Professions and the Virginia State Police, 2004. 79p. Source: Internet Resource: Accessed July 14, 2011 at: http://www.dhp.virginia.gov/dhp_programs/pmp/docs/REPORT%20OF%20THE%20PMP.pdf Year: 2004 Country: United States URL: http://www.dhp.virginia.gov/dhp_programs/pmp/docs/REPORT%20OF%20THE%20PMP.pdf Shelf Number: 122060 Keywords: Drug Abuse and AddictionIllicit DrugsPrescription Drug Abuse (Virginia)Prescription Fraud |
Author: McGregor, Catherine Title: Prescription Drug Use Among Detainees: Prevalence, Sources and Links to Crime Summary: This report is the first of its kind in Australia to examine the self-reported use of illicit pharmaceuticals among a sample of police detainees surveyed as part of the Australian Institute of Criminology’s Drug Use Monitoring in Australia (DUMA) program. In all, 986 detainees were interviewed, of which 19 percent reported having recently used pharmaceutical drugs for non-medical purposes in the past 12 months — nearly five times as high as reported by the general Australian population. Non-medical prescription drug use was found to be substantially higher in the detainee population by comparison with the general community. Among the detainees surveyed, more prescription drug users were unemployed, derived their income from welfare or benefits, considered themselves drug dependent, were currently on a drug-related charge and had been arrested or imprisoned in the previous 12 months by comparison with non-users. Most pharmaceuticals were sourced from family and friends or from the person’s usual doctor and pharmacy. There was little support for the view that pharmaceuticals are commonly obtained through script forgery or over the internet. Benzodiazepines, followed by opioids, were the most commonly used pharmaceuticals for non-medical purposes in this sample of police detainees. This paper provides policymakers with valuable information about the reasons for use and the methods by which pharmaceuticals are typically accessed for non-medical purposes. Further research to investigate the methods of obtaining illicit pharmaceuticals from within the general community is needed. Details: Canberra: Australian Institute of Criminology, 2011. 6p. Source: Internet Resource: Trends & Issues in Crime and Criminal Justice, No. 423: Accessed August 11, 2011 at: http://www.aic.gov.au/publications/current%20series/tandi.aspx Year: 2011 Country: Australia URL: http://www.aic.gov.au/publications/current%20series/tandi.aspx Shelf Number: 122361 Keywords: Drug Abuse and CrimeDrug OffendersPrescription Drug AbusePrescription Fraud |
Author: Ohio Prescription Drug Abuse Task Force Title: Ohio Prescription Drug Abuse Task Force Final Report: Task Force Recommendations Summary: On April 2, 2010, Governor Ted Strickland signed Executive Order 2010-4S, establishing the Ohio Prescription Drug Abuse Task Force (the “Task Force”). The Task Force was created to develop a coordinated and comprehensive approach to Ohio’s prescription drug abuse epidemic. The group was comprised of 33 members with a wide range of professional backgrounds and perspectives, including: state and local public health officials, health provider board and association representatives, state and local law enforcement, local government officials, state agency representatives and legislators. The Task Force was charged with meeting regularly to develop and recommend potential remedies to the growing misuse and abuse of prescription drugs in Ohio. Due to the urgency of this problem, the Task Force was required to submit an initial progress report to the Governor and the leaders of the Ohio General Assembly by May 17, 2010. The progress report included initial recommendations encouraging support for community education efforts (i.e. drug take back programs and social marketing campaigns) and charged the Task Force Work Groups to explore and identify potential solutions for the Task Force Final Report. Since the submission of the initial progress report, the Task Force and its Work Groups met frequently and have developed 20 recommendations. In order to ensure the state’s approach is both multifaceted and comprehensive, the recommendations address issues related to treatment, law enforcement, public health and regulation. In accordance with Executive Order 2010-4S, and in support of the Governor’s mission to reduce prescription drug abuse in Ohio, the Task Force hereby issues this final report. Details: Columbus: The Task Force, 2010. 75p. Source: Internet Resource: Accessed November 7, 2011 at: http://www.odh.ohio.gov/ASSETS/895B95C591534F7A82A815A69A00011E/OPDATF%20final%20report.pdf Year: 2010 Country: United States URL: http://www.odh.ohio.gov/ASSETS/895B95C591534F7A82A815A69A00011E/OPDATF%20final%20report.pdf Shelf Number: 123254 Keywords: Drug AbusePrescription Drug Abuse (Ohio)Prescription Fraud |
Author: New York (State). Office of the Attorney General Title: Internet System for Tracking Over-Prescribing (I-STOP): A Proposal Addressing New York's Prescription Drug Abuse and Drug Diversion Epidemic Summary: Prescription drug diversion involves channeling legitimately produced controlled substances from their lawful purpose into illicit drug traffic. Abuse of diverted drugs comprises the nation’s fastest growing drug problem, and in recent years has reached epidemic proportions. It affects every sector of society, straining our healthcare and criminal justice systems, and endangering the future of our younger generations. Painkiller overdoses nationwide killed nearly 15,000 people in 2008. In New York, the number of prescriptions for all narcotic painkillers has increased from 16.6 million in 2007 to nearly 22.5 million in 2010 - prescriptions for hydrocodone have increased 16.7 percent, while those for oxycodone have increased an astonishing 82 percent. In New York City, the rate of prescription pain medication misuse among those age 12 or older increased by 40 percent from 2002 to 2009, with nearly 900,000 oxycodone prescriptions and more than 825,000 hydrocodone prescriptions filled in 2009. The roots of the problem are two-fold. First, a lack of education and communication between practitioners significantly increases the likelihood of over-prescribing and dangerous drug interaction. Second, access to an ever-increasing supply of prescription narcotics, through legal or illegal means, has grown four-fold in the past decade. Virtually all observers of prescription drug diversion agree that expanding the use of Prescription Monitoring Programs (PMPs), and enhancing the quality and availability of the data they collect, are essential to the solution. The federal Governmental Accountability Office (GAO), the Centers for Disease Control and Prevention (CDC), the insurance industry, the White House, and independent researchers all point to such an expansion as a key part of the solution to prescription drug fraud, abuse and diversion. While New York’s PMP collects critical data on prescription drugs dispensed by pharmacists, the current system is outdated with regard to how and when data is collected, who has access to it, and how it is used. New York State Attorney General Eric T. Schneiderman has introduced a program bill in the State Legislature that would exponentially enhance the effectiveness of New York’s existing PMP to increase detection of prescription fraud and drug diversion. A.8320 (Cusick)/S.5720 (Lanza) would enact the Internet System for Tracking Over-Prescribing (I-STOP) Act, to establish an on-line, real-time, controlled substance reporting system that requires prescribers and pharmacists to search for and report certain data at the time a controlled substance prescription is issued, and at the time such substance is dispensed. The legislation would: • require the Department of Health to establish and maintain an on-line, real-time controlled substance reporting system to track the prescription and dispensing of controlled substances; • require practitioners to review a patient's controlled substance prescription history on the system prior to prescribing; • require practitioners or their agents to report a prescription for such controlled substances to the system at the time of issuance; • require pharmacists to review the system to confirm the person presenting such a prescription possesses a legitimate prescription prior to dispensing such substance; • require pharmacists or their agents to report dispensation of such prescriptions at the time the drug is dispensed. I-STOP will vastly enhance the effectiveness of the present system. Its goal is to enable doctors and pharmacists to provide prescription pain medications, and other controlled substances, to patients who truly need them. At the same time, it will arm them with the necessary data to detect potentially dangerous drug interactions, identify patterns of abuse by patients, doctors and pharmacists, help those who suffer from crippling addictions and prevent potential addiction before it starts. Details: Albany, NY: New York State Office of the Attorney General, 2012. 43p. Source: Internet Resource: Accessed January 17, 2012 at: http://www.ag.ny.gov/media_center/2012/jan/ISTOP%20REPORT%20FINAL%201.10.12.pdf Year: 2012 Country: United States URL: http://www.ag.ny.gov/media_center/2012/jan/ISTOP%20REPORT%20FINAL%201.10.12.pdf Shelf Number: 123644 Keywords: Drug Abuse and AddictionIllicit Drug MarketsPrescription Drug Abuse (New York State)Prescription Fraud |
Author: Yearwood, Doug Title: Prescription Drug Abuse and Diversion: The Hidden Crisis Summary: This report addresses public concerns about increased misuse, abuse and illegal diversion of licit or prescription medications in North Carolina. The study indicates that prescription drug abuse and diversion is a prominent and preeminent issue facing North Carolina’s medical and law enforcement organizations and personnel. Ninety percent of the law enforcement respondents reported an increase in abuse and diversion over the past five years, with the typical agency investigating 51 prescription drug cases per year or 356 per year on a per capita basis. This case investigation rate exceeds the reported crime rates for all of the violent Part I Uniform Crime Report categories. Details: Raleigh, NC: North Carolina Governor's Crime Commission, Criminal Justice Analysis Center, 2011. 22p. Source: Internet Resource: Accessed January 20, 2012 at: http://www.ncgccd.org/pdfs/pubs/drugdiversion.pdf Year: 2011 Country: United States URL: http://www.ncgccd.org/pdfs/pubs/drugdiversion.pdf Shelf Number: 123686 Keywords: Drug Abuse and AddictionDrug EnforcementDrug OffendersPrescription Drug Abuse (North Carolina)Prescription Fraud |
Author: Butler, Steve Title: Scheduled Prescription Drug Distribution in Wyoming: Analysis of the Wyoming Prescription Drug Monitoring Program 2004-2009 Summary: The Wyoming Survey & Analysis Center (WYSAC) at the University of Wyoming proposed this research project as part of the 2010 State Justice Statistics Program for Statistical Analysis Centers. Accepted projects were funded by the Bureau of Justice Statistics. The study examines statewide prescribing patterns of Schedule II and above drugs as recorded through the Wyoming Prescription Drug Monitoring Program (PDMP). PDMPs are databases that contain prescribing information of drugs that have high potential for abuse, such as opioids, benzodiazepines, stimulants, and barbiturates, among others (Schedule II and above). In Wyoming and other states, PDMPs have primarily been used to assist doctors and pharmacists in identifying patients who might be attaining illicit access to drugs through doctor-shopping and fraudulent prescription scams. Also helping states to understand legitimate scheduled drug prescribing, PDMPs analysis reveals the scale and scope of scheduled drug distribution, both geographically and over time. Testament of the usefulness of PDMPs is demonstrated through their proliferation throughout the U.S.: In 2002 only nineteen states had PDMPs and as of 10/2008 forty-seven states had such systems. In the 2002 United States General Accounting Office report, Prescription Drugs: State Monitoring Programs Provide Useful Tools to Reduce Diversion, the GAO asserted that PDMPs in some states were used to evaluate prescribing patterns in order to identify medical practitioners who are overprescribing. After identifying possible cases, PDMP officials inform doctors that their patterns are unrepresentative of the greater medical community, and thereby attempt to influence prescribing by educating practitioners. PDMPs also identify patients who are abusing or diverting prescription drugs for sale on the black-market and provide this information to doctors and pharmacists. Programs that educate physicians, pharmacies, and the public about the existence of diversion scams, along with the tactics employed, are constructive outcomes of the public dissemination of PDMP analyses. Once educated about diversion tactics, key stakeholders can become a substantial force in the prevention of abuse and diversion. For example, based on PDMP analysis in Nevada and Utah, physicians were sent drug utilization letters containing information that signaled potential diversion activity, including the number and types of drugs prescribed. Here in Wyoming, a RX Abuse Stakeholders was created in 2008 and is chaired by the U.S. Attorney’s Office. Representatives from health care, government, law enforcement and community members serve on the taskforce. The mission is to prevent the increasing abuse of prescription medications while ensuring that they remain available for patients in need. Methods of advancement include educating healthcare professionals, law enforcement and the general public about use and abuse of scheduled drugs, and strengthening the regulatory framework. The Wyoming State Board of Pharmacy manages the PDMP and according to Wyoming statute, legitimate uses of the system include: “release of information to practitioners and pharmacists when the release of the information may be of assistance in preventing or avoiding inappropriate use of controlled substances; The board shall report any information that it reasonably suspects may relate to fraudulent or illegal activity to the appropriate law enforcement agency and the relevant occupational licensing board and the board may release data for educational, research or public information purposes” (W.S 35-7-1060). Data for this study consists of all Wyoming PDMP records from 2004 through 2009. Prior to this project, no comprehensive study has been conducted on the distribution of prescribed Schedule II, III, and IV drugs as recorded in the Wyoming PDMP. Details: Laramie, WY: Wyoming Survey & Analysis Center, University of Wyoming, 2011. 307p. Source: Internet Resource: WYSAC Technical Report No. CJR-1007: Accessed May 4, 2012 at: https://wysac.uwyo.edu/ReportView.aspx?DocId=479&A=1 Year: 2011 Country: United States URL: https://wysac.uwyo.edu/ReportView.aspx?DocId=479&A=1 Shelf Number: 125158 Keywords: Prescription Drug AbusePrescription Drugs (Wyoming)Prescription Fraud |
Author: Almashat, Sammy Title: Pharmaceutical Industry Criminal and Civil Penalties: An Update Summary: In December 2010, Public Citizen published a report that, for the first time, documented all major financial settlements and court judgments between pharmaceutical manufacturers and the federal and state governments since 1991. At the time of the report’s publication, almost $20 billion had been paid out by the pharmaceutical industry to settle allegations of numerous violations, including illegal, off-label marketing and the deliberate overcharging of taxpayer-funded health programs, such as Medicare and Medicaid. Three-fourths of the settlements and accompanying financial penalties had occurred in just the five-year period prior to 2010. At the time of the report’s publication, there was no indication that this upward trend was subsiding. The following study was undertaken to assess the level of settlement activity from the previous report through the first half of 2012 – an additional 1 ½ years – and to conduct, for the first time, an analysis of the results of individual state enforcement efforts since 1991. Methodology from the 2010 report was largely replicated, with all federal and state government settlements, of $1 million or greater, reached with pharmaceutical manufacturers from November 2, 2010 through July 18, 2012 included in the current study. In addition, a 50-state analysis of settlement activity, going back to 1991, was conducted for the first time on state settlements that did not involve the federal government. State settlements were classified as single-state settlements (those in which only one state was a party to the final settlement) or multi-state settlements (all other state settlements). A total of 74 additional settlements, totaling $10.2 billion in financial penalties, were reached between the federal and state governments and pharmaceutical manufacturers between November 2, 2010 and July 18, 2012, with the first half of 2012 alone already representing a record year for both federal ($5.0 billion) and state ($1.6 billion) financial recoveries. Since 1991, a total of 239 settlements, for $30.2 billion, have now been reached (through July 18, 2012) between federal and state governments and pharmaceutical companies. Other key findings included: - Single-state settlements have been responsible for most of the recent increase in settlement activity, comprising almost three-fifths (59%) of all settlements since the beginning of 2009, compared to only one-fourth (25%) of settlements prior to 2009. - Since 1991, 27 states have reached at least one single-state settlement with a pharmaceutical company. Kentucky has had the most single-state settlements (17) while Texas has had the highest number of single-state settlements resulting from actions initiated by private whistleblowers (6). - Seventeen of the 27 states with at least one single-state settlement since 1991 have attained a return on investment of $1 or greater for every dollar spent on enforcement of all (both pharmaceutical-related and non-pharmaceutical) Medicaid fraud. - Since 2009, the federal government has concluded almost as many settlements and recovered more in financial penalties as it had in the previous 18 years combined. - Whistleblower-initiated investigations were responsible for most federal settlements (75%) and financial penalties (78%) during the current study period. - As in the previous study, overcharging government health insurance programs, mainly drug pricing fraud against state Medicaid programs, was the most common violation, while the unlawful promotion of drugs was associated with the largest penalties. The past two years have seen a continuation of the recent trend of record settlements between the federal and state governments and pharmaceutical manufacturers. A much larger proportion of these recent settlements have been brought about by individual state investigations than in previous years which, in most states involved in such litigation, has resulted in financial recoveries that more than offset enforcement expenses. However, despite the scale of the fraud against their Medicaid programs and the potential recoveries at stake, most states, including some with the highest prescription drug expenditures, have yet to pursue investigations on their own. On a federal level, financial penalties still continue to pale in comparison to company profits and a parent company is only rarely excluded from participation in Medicare and Medicaid for the illegal activities, which endanger the public health and deplete already overstretched taxpayer-funded programs. In what will hopefully represent an emerging trend, the federal government has recently pursued criminal charges against key company employees and executives, but the cases so far have either been thrown out or resulted in minor sentences. Stronger legislation and more robust enforcement are needed on a federal and state level to deter future unlawful behavior. Details: Washington, DC: Public Citizen, 2012. 50p. Source: Internet Resource: Accessed October 3, 2012 at: http://www.citizen.org/documents/2073.pdf Year: 2012 Country: United States URL: http://www.citizen.org/documents/2073.pdf Shelf Number: 126544 Keywords: Corporate CrimeFraud and CorruptionMedicaid FraudPrescription FraudWhistleblowersWhite Collar Crime, Pharmaceutical Industry |
Author: U.S. Government Accountability Office Title: Medicaid: Additional Reporting May Help CMS Oversee Prescription-Drug Fraud Controls Summary: GAO found indicators of potential prescription-medication fraud and abuse among thousands of Medicaid beneficiaries and hundreds of prescribers during fiscal year 2011-the most-recent year for which reliable data were available in four selected states: Arizona, Florida, Michigan, and New Jersey. These states accounted for about 13 percent of all fiscal year 2011 Medicaid payments. Specifically, in these four states, GAO found the following: - More than 16,000 of the 5.4 million beneficiaries potentially engaged in "doctor shopping," by visiting five or more doctors to receive prescriptions for antipsychotics or respiratory medications valued at about $33 million. - About 700 beneficiaries received more than a 1-year supply of the same drug in 2011 at a cost to Medicaid of at least $1.6 million. This is an indicator of diversion, which is the redirection of prescription drugs for illegitimate purposes. As required by federal law, the Medicaid Drug Utilization Review program is a two-phase review process states use to promote safety while also monitoring prescription-drug activity for fraud. Federal law requires each state to report on the operation of its review program, a key monitoring tool that the Centers for Medicare & Medicaid Services (CMS) uses to oversee the review process in states, but GAO identified additional actions that could improve oversight. In the first phase, states use tools and eligibility screening to promote patient safety and avoid abuse before the drugs are dispensed. The second phase involves ongoing and periodic examination of claims data to identify patterns of fraud, abuse, gross overuse, or medically unnecessary care, and implement corrective action when needed. However, GAO identified two potential controls that are not included in CMS's current reporting requirements: - Lock-in programs for noncontrolled substances. Lock-in programs address doctor shopping by restricting beneficiaries who have abused the Medicaid program to one health-care provider, one pharmacy, or both, for receiving prescriptions. Lock-in programs have typically been used on controlled substances. Expanding lock-in programs that currently focus on controlled substances to restrict abusers of noncontrolled substances, such as the human immunodeficiency virus medications Atripla and Truvada, to a single prescriber or pharmacy may help address potential fraud and abuse. - Prohibition of automatic refills. Pharmacies permitting automatic refills automatically refill prescriptions for certain medications without any customer action. Concerns with pharmacy automatic refill include the potential for stockpiling, continued fill of discontinued medications, and increased cost and waste of prescription medications. Two states GAO reviewed-Florida and Arizona-have prohibited the practice. CMS does not collect information about lock-in programs for noncontrolled substances or automatic refill prohibitions, but doing so would help the agency determine whether additional guidance is needed. Details: Washington, DC: GAO, 2015. 64p. Source: Internet Resource: GAO-15-390: Accessed August 14, 2015 at: http://www.gao.gov/assets/680/671241.pdf Year: 2015 Country: United States URL: http://www.gao.gov/assets/680/671241.pdf Shelf Number: 136423 Keywords: Medicaid Fraud and AbuseMedical FraudPrescription Fraud |
Author: U.S. General Accounting Office Title: Health Care Fraud: Information on Most Common Schemes and the Likely Effect of Smart Cards Summary: What GAO Found GAO's review of 739 health care fraud cases that were resolved in 2010 showed the following: - About 68 percent of the cases included more than one scheme with 61 percent including two to four schemes and 7 percent including five or more schemes. - The most common health care fraud schemes were related to fraudulent billing, such as billing for services that were not provided (about 43 percent of cases) and billing for services that were not medically necessary (about 25 percent). - Other common schemes included falsifying records to support the fraud scheme (about 25 percent), paying kickbacks to participants in the scheme (about 21 percent), and fraudulently obtaining controlled substances or misbranding prescription drugs (about 21 percent). - Providers were complicit in 62 percent of the cases, and beneficiaries were complicit in 14 percent of the cases. GAO's analysis found that the use of smart cards could have affected about 22 percent (165 cases) of cases GAO reviewed in which the entire or part of the case could have been affected because they included schemes that involved the lack of verification of the beneficiary or provider at the point of care. However, in the majority of cases (78 percent), smart card use likely would not have affected the cases because either beneficiaries or providers were complicit in the schemes, or for other reasons. For example, the use of cards would not have affected cases in which the provider misrepresented the service (as in billing for services not medically necessary), or when the beneficiary and provider were not directly involved in the scheme (as in illegal marketing of prescription drugs). Details: Washington, DC: GAO, 2016. 46p. Source: Internet Resource: GAO-16-216: Accessed February 22, 2016 at: http://www.gao.gov/assets/680/674771.pdf Year: 2016 Country: United States URL: http://www.gao.gov/assets/680/674771.pdf Shelf Number: 137935 Keywords: Illegal MarketsMedical FraudPrescription Fraud |