Chris Covington, Assistant Special Agent in Charge for the Atlanta Regional Office, is interviewed by Todd Silver, a senior communications specialist in Washington, D.C.
From the Office of Inspector General of Department of Health and Human Services
Todd Silver: In May 2018, Kentucky physician Dr. Charles Fred Gott was sentenced to more than 8 years in prison.
Dr. Gott was one of the highest prescribers of opioids in an area where the opioid crisis has reached epidemic proportions.
According to the National Institute on Drug Abuse, there were nearly a thousand opioid-related overdose deaths in Kentucky alone in 2016.
On a per-person average, that's nearly double the national rate.
The Dr. Gott case is an example of a "one-man crime wave" causing tremendous damage in a small community.
Joining me to talk about the case is Chris Covington, an assistant special agent in charge for the Department of Health and Human Services, Office of Inspector General. Chris, welcome to the podcast.
Chris Covington: Thanks so much Todd, I'm glad to be here.
TS: Let's dive right into this case. How did you first hear about the case?
CC: The case actually came to us from the United States attorney's office in Louisville Kentucky. They reached out to us because they were working with some other federal agencies on a case against Dr. Fred Gott, who was a cardiologist who had gone into the pain management business.
What happened is the agents discovered that Dr. Gott was performing an EKG on every patient, every three months. But it's not something that you usually get, certainly not on a quarterly basis, unless you've got some kind of cardiac problem. And most of Dr. Gott's patients were pain patients.
Another thing that Dr. Gott was doing is there's a test called a spirometry, and a spirometry is basically blowing in into a tube to test your lung capacity. It's something that you might have for a physical, but unless you have some type of respiratory disorder, it would be very unusual to get a spirometry on a regular basis. And again, Dr. Gott was performing spirometries on every patient, every three months.
TS: So, did he have a justification for why he was billing for these other tests that didn't seem to deal with pain management at all?
CC: What was funny about the Dr. Gott case is as soon as agents did a search warrant, Dr. Gott actually instructed staff to stop billing for the EKGs and the spirometries. We think that's a very good indication that those tests were never medically necessary.
TS: What else did you find out about Dr. Gott?
CC: Dr. Gott was not doing the types of things that we expect pain management physicians to do. He wasn't requiring that patients to get diagnostic procedures like an MRI that would help pinpoint the source of the pain. He wasn't referring patients to things like physical therapy, which might be a way to relieve pain other than the opioids. His intention was to keep those patients addicted, keep those patients coming in so he could continue to bill Medicare, Medicaid, and other insurers for these tests.
Do we know why he moved from cardiology to opening a pain management clinic?
CC: What we believe is that Dr. Gott's time as a cardiologist had simply not been profitable for him. And as we've seen in other cases we think he simply shifted to pain management because it was an opportunity for him to make more money. The patients that were coming to see Dr. Gott were addicted to the drugs, and it gave him the opportunity to bill for these medically unnecessary tests when the patient came in for the prescription.
TS: How big an opioids prescriber was he in Kentucky?
CC: Dr. Gott actually was one of the top prescribers of methadone, which is a somewhat unusual drug to see a pain management practice prescribing. Methadone is something that is more often used for treating opioid addiction and Dr. Gott was the largest biller of methadone in the area of western Kentucky where he practiced.
TS: And methadone is an opioid, correct?
CC: Methadone is an opioid. It's designed to help combat the effects of addiction that many patients who are taking opioids suffer from.
TS: And what was the advantage for him to prescribe methadone instead of other opioids?
CC: One, is that there were very few providers in the area that prescribed methadone. So if he was able to get a patient addicted to methadone, they were going to have to keep coming back to see Dr. Gott because they had no other choices. Another reason is that it often involved the patient coming back with greater frequency. So for example he might have a patient come every week when he started the methadone treatment and then every two weeks, and at the end of the day that was better for him because he was getting more frequent patient visits than if the patient was on a drug that for example only required a monthly prescription.
TS: How did he add to the opioid epidemic?
CC: Well Dr. Gott like so many of these opioid prescribers are a one-man crime wave. They are able to cause tremendous damage in a fairly small, rural community by addicting patients to these drugs and that has a cascading effect, it impacts families, it impacts the ability of these patients to hold down a job, and it ultimately can end up resulting in these patients not only becoming addicts but finding their way to the ER or the grave.
When you're dealing with opioid medications, they are extremely dangerous.
There was one particular patient that we interviewed who had suffered two overdoses that sent her to the ER, and that patient's mother actually told Dr. Gott that he was going to kill her daughter if he didn't stop prescribing her these opioids.
TS: What kind of message does his sentence send to other bad actors who may be overprescribing opioids?
CC: The fact that he got an 8 year sentence is the type of sentence that tells other over prescribers that there are serious consequences to these actions. The damage that you're doing to your patients, the damage that you're doing to your community, can result in very serious consequences for you.
TS: What is HHS OIG doing to find these bad actors, and what are they doing to help curb the crisis?
CC: One of the things that HHS is doing is partnering with other federal law enforcement agencies, like the FBI, like the Drug Enforcement Administration, like the State Medicaid Fraud Control Units to identify these over prescribers and bring to bear numerous resources to combat this problem. If we can take one of these opioid over prescribers off the board we are basically preventing additional patients from becoming addicted.
TS: And that includes the new Opioid Fraud Detection Units I assume. What do they bring to the table?
CC: They have a tremendous amount of data resources to identify the doctors who are overprescribing opioids and they have hired dedicated opioid prosecutors to tackle these types of cases. And I think what you're going to see is more physicians indicted for overprescribing because of this new collaborative effort.
TS: Thank you Chris for speaking with us today about this very important topic.
CC: Thanks so much Todd.
TS: I'm Todd Silver, thanks for listening, and remember to check out our podcast page for other interesting podcasts.