As the opioid crisis continues to ravage parts of the United States, healthcare fraud lawyers continue to see a rise in fraudulent claims for opioids painkillers. As a result, the government has taken steps against companies involved in this type of wrongdoing. For instance, last month Johnson & Johnson paid more than $2 billion in penalties to resolve allegations that it helped fuel the opioid crisis.
According to healthcare lawyer Ileana Hernandez of Manatt, with Johnson & Johnson out of the picture, other companies are still profiting from opioids painkillers to fuel illegal activity. And this type of fraudulent activity is not limited to opioids. With the demand for these drugs on the rise, there is also an increase in claims filed by “doctor shoppers” who go from one physician to another looking for the same prescription drugs.
“There are always new schemes that unfortunately tend to pop up, especially when there’s money involved,” says Hernandez.
According to Hernandez, with an uptick in opioid prescriptions, healthcare fraud investigations have also grown more profitable than ever before. These investigations typically involve doctors that write prescriptions for patients who do not need opioids or other types of medication.
“What we see now in our investigations is a lot more kickbacks,” says Hernandez. “So, instead of giving out the pills for free, they give money to companies, and they send employees there.”
She added: “When the company sends employees to the doctor’s office, they will file for reimbursement, and those opioids go straight into the hands of addicts.”
For instance, in 2016, Alabama-based pharmacy SONA LLC pleaded guilty to conspiring with a network of Alabama physicians and pain clinics. The pharmacies paid cash kickbacks to physicians who prescribed highly addictive controlled substances, such as oxycodone, to their patients.
“It’s all about the money, and as long as (healthcare fraud) is about the money, it makes it very difficult because people will always find a way to make money,” says Hernandez.
The opioid crisis has also made healthcare fraud more dangerous for those working in pharmacies or companies that handle insurance claims.
“Healthcare fraud also hurts the public,” says Hernandez. “There is such a cost, not only monetarily but (in terms of) human lives.”
She said: “And it’s unfortunate because we’re talking about men and women that are working hard to provide for their families; they end up resorting to this because they have to put food on the table. And it’s just a vicious cycle.”
In addition to being more dangerous, healthcare fraud investigations are also more difficult for companies and government agencies trying to stop them.
“A lot of times, there is no paper trail,” says Hernandez. “It’s very easy for these types of things to happen because a lot of times prescriptions are being filed electronically, and it’s hard to trace.”
“So, what we see now is … you have a patient showing up at 10:00 in the morning, and then another one comes in two hours later, and then there’s another one that shows up before lunch. And they all arrive at their visits at the same time,” she added.
“The system is set up in a way that you can’t follow up if somebody needs to be followed because it’s going to take too much manpower, and I think that’s what we’re seeing.”