Tuesday, August 27, 2013

Colorado Doctor Indicted For Health Care Fraud, Distributing Controlled Substances And Other Charges Arising From Pain Management Practice

On August 26, 2013, a federal grand jury in Colorado issued an indictment last week for doctor Joel E. Miller in Craig, Colorado that accused him of prescribing controlled substances in quantities and dosages that resulted in abuse, misuse, addiction and death. A copy of the Indictment can be found here. There are 35 counts against him including health care fraud for billing to Medicare and Medicaid, distributing controlled substances, money laundering and forfeiture. 

This is a continued trend in physicians being charged as if they are drug traffickers. Any physician who prescribes scheduled narcotics needs to make sure that their practice is reviewed for all compliance and ensure that the evolving standard of care is being met. Even one patient in today’s world can result in charges since under the law, only if there is medical necessity and legitimate medical need (as established by the standard of care along with the record keeping required). 

Practicing physicians can learn from the allegations in the Indictment and think about them in the context of their everyday pain management practices. The Indictment alleges that Dr. Miller engaged in the following scheme which supports the charges filed against him :

(1) prescribed quantities and combinations of controlled substances to patients but failed to adequately medically address the misuse and abuse of the prescribed controlled substances of the patients

(2) prescribed controlled substances to patients knowing that his patients were addicted to the controlled substances, were misusing the controlled substances, or "doctor-shopping," and were requesting additional quantities of controlled substances to support the patients' drug habits;

(3)  prescribed controlled substances in quantities and dosages that would cause patients to abuse, misuse, and become addicted to the controlled substances;

(4) required patients to pay for follow-up visits to obtain additional prescriptions for controlled substances

(5) prescribed controlled substances to patients knowing that his prescribing endangered his patients' lives, and if taken as directed, his prescriptions would be expected to result in accidental overdoses;

(6) prescribed controlled substances to patients without determining a sufficient medical necessity for the prescription of controlled substances;

(7) prescribed controlled substances to patients in a manner which was inconsistent with the usual course of professional practice and for other than legitimate medical purpose;

(8) prescribed pharmaceuticals to patients for whom the prescription was not intended, and directed the persons to whom he prescribed the pharmaceuticals to give the prescription to third parties

(9) prescribed controlled substances to patients in such strengths and quantities that his prescribing became a contributing factor in the patients' overdose deaths; and

(10) pre-signed prescriptions and allowed office employees to distribute controlled substance prescriptions to patients in his absence and without a doctor's examination of the patient.

What can prescribing physicians learn from this Indictment even when they are doing their best to run a practice that is compliant? It is critical to address patients' abuse of prescribed substances, any addiction issues, potential diversion or misuse, and office procedures. The standard of care goes beyond the practice of medicine and it is critical that there is documentation and procedures in place that help follow up on any "red flags" or patients who are addicted, abusing or who have grown opiant tolerant or have dosages that pose risks to the patients. Make sure your practice is the type that an expert could review and indicate that you are following the standard of care with respect to these issues. Prevention in these cases is the best medicine. 

Posted by Tracy Green, Green and Associates, Attorneys at Law


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