Pill Mills and Prescribers, Opioid-Related Exclusions
In association with the 2017 National Health Care Fraud Takedown, the Department of Health and Human Services Office of Inspector General's Exclusions Program issued notices to 295 individuals based on the conduct related to opioid diversion and abuse. These notices represent doctors that operate a pill mill; nurses reporting for duty impaired due to diversion from patient or employer pill stock; and pharmacists and pharmacy technicians stealing pills and other similar conduct.
Top 5 States with Exclusions
- New York: 30 exclusions
- Massachusetts: 24 exclusions
- Texas: 23 exclusions
- Pennsylvania: 22 exclusions
- North Carolina: 21 exclusions
Exclusions by Occupation
- 162 Nurses
- 57 Doctors
- 37 Pharmacy Services
2017 Takedown by the Numbers
- 412 Defendents Charged, Including
- 115 Medical Professionals
- $1.3 Billion in Losses
- 41 Federal Districts
- 30 Medicaid Fraud Control Units
- 295 Exclusion Notices
- 350 OIG Agents
Source: DOJ and HHS OIG
In 2016, Medicare Part D covered 44 million beneficiaries. 1 in 3 beneficiaries received opioids. 1 in 10 beneficiaries received opioids on a regular basis. Continuous use of opioids increases the risk of opioid dependence.
Half a million part D beneficiaries received high amounts of opioids in 2016. These beneficiaries received an average daily dose of opioids, equivalent to taking more than 12 vicodin tablets (10mg) or 16 percocet tablets (5mg). These dosages far exceed the amounts CDC recommends avoiding.
Here's an example of a beneficiary receiving extreme amounts of opioids: a beneficiary in New York received 62 opioid prescriptions for fentanyl and oxycodone in one year. That's more than 1 prescription per week. The patient's average daily dose was almost 35 times the level that CDC recommends avoiding.
401 prescribers around the country had questionable opioid prescribing patterns for beneficiaries at serious risk of misuse or overdose. In one example of questionable prescribing: 1 doctor wrote 1,200 prescriptions for beneficiaries at serious risk of misuse or overdose. What can happen with excess drugs? Drugs can be diverted for resale or used recreationally. People can misuse or overdose on powerful opioids.
Source: OIG analysis of Medicare Part D data, 2017
Learn more at https://oig.hhs.gov/opioidsbrief