Alaska Board of Pharmacy Sends Letter to its Pharmacists Sending Mixed Signals Over Filling Opioid Prescriptions (Part 1 of a 2 part series)

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The “Opioid Crisis” in the U.S.

We all know that there is an “opioid crisis” in the U.S. It is probably prevalent in every state. In Florida we have been suffering under it for the past ten to fifteen years. So it is nothing new to Florida. Government regulators including, but not limited to the Florida Department of Health (DOH), Florida Attorney General (AG), different State’s Attorneys’ (prosecutors) offices, multi-jurisdictional task forces, local law enforcement agencies, the U.S. Drug Enforcement Administration (DEA) and the Department of Justice (DOJ), along with federal prosecutors, have been involved in ongoing efforts in Florida for the past fifteen years or so, to shut down “pill mills” and attempt to eliminate the “opioid crisis.” Florida was, unfortunately, leading this trend.

The “Opioid Crisis;” Nothing New in Florida.

During this same period of time, my firm and I have been involved in defending physicians and pharmacists in criminal, civil, and administrative actions seeking to prosecute them, revoke their licenses, revoke their DEA registrations, terminate them from Medicaid participation, levy fines on them and other punitive actions. Florida was also, unfortunately, leading this trend.

So our opinions and comments in this blog, Part 1, and its Part 2, are informed by long years of experience with something that is old news in Florida, but may be new news in other states.

Alaska Sends out its Warning to Pharmacists to Keep Filling Prescriptions for Opioids.

On January 23, 2019, the Chairman of the Alaska Board of Pharmacy sent out an open letter to Alaska pharmacists, discussing the negative effect on patient health that has arisen in response to the fact that many pharmacists have stopped filling prescriptions for opioids. From its tone, it warns pharmacists to keep filling such prescriptions under threat of possible disciplinary action against their licenses, at least that is my interpretation of it. Here is a copy you can read for yourself, click here.

The two-page letter begins by stating:

The [Alaska] Board of Pharmacy has had an influx of communication concerning patients not able to get controlled substance prescriptions filled for various reasons, even when signs of forgery or fraudulence were not presented.

The letter continues stating:

As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation. These laws are: AS [Alaska Statutes] 08.80.261 DISCIPLINARY ACTIONS.

It then continues, quoting and citing other statutes and administrative codes under which a pharmacist could be charged for refusing to fill an opioid prescription for a patient.

Chilling? Mixed Signals? You be the Judge!

The problem I have is where is the state board of pharmacy (in any state, not just Alaska), when the DEA comes in to the pharmacy with its search warrants and arrest warrants? Where is the state board of pharmacy when the raid by local police/sheriff/multi-jurisdictional task force comes into the pharmacy? Where is the state board of pharmacy when the U.S. Attorney’s Office indicts and prosecutes the pharmacist? Where is the state board of pharmacy when the DEA issues its Order to Show Cause (OTSC) why the pharmacy’s or pharmacist’s DEA registration should not be revoked.

The state board of pharmacy is usually the one providing the expert witnesses to testify against the pharmacist or pharmacy, that’s where. The state board of pharmacy is standing by ready to take disciplinary action against the pharmacist or pharmacy, after the other government agencies get finished.

If pharmacists and pharmacies are refusing to fill prescriptions for opioids, which is something that I advise my clients to do, if they can afford to do so, then that is a smart move, until state agencies, including the state boards of pharmacy, take action to help them out of this predicament. The pharmacists are caught on the horns of a dilemma: face federal and state criminal prosecutions and actions by the DEA for filling opioid prescriptions; or face possible administrative actions by the state board of pharmacy for not filling opioid prescriptions. My advice is to choose the latter as it is much easier to defend a state administrative action, especially if you are not trying to do so from a federal prison somewhere.

The cost of defending a DEA action to revoke a DEA registration is prohibitive if done correctly, even if the pharmacist is completely innocent of any wrongdoing. The goal of these proceedings, despite the innocence of the pharmacist or pharmacy, is to put them out of business, and it almost always succeeds! Click here to read one of my prior blogs about DEA investigations of health care professionals.

To read my additional opinions on the types of actions that can be taken by states and state agencies to address the issues which the Alaska Board letter attempts to address, please see Part 2 of this blog. To read more on pill mill cases in the state of Florida, click here.

To learn more on administrative and informal hearings before the Florida Board of Pharmacy, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The Firm also represents both plaintiffs (whistle blowers or relators) and defendants in False Claims Act (whistle blower or qui tam) cases. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: legal representation for pharmacists, legal representation for pharmacies, pharmacy defense attorney, pharmacist defense lawyer, board representation for pharmacists, board representation for pharmacies, board representation for physicians, Board of Pharmacy investigation representation, legal representation for board investigations, administrative hearing defense attorney, representation for administrative hearings, administrative complaint representation, Board of Medicine representation, Board of Medicine attorney, Board of Medicine defense attorney, representation for Board of Medicine investigations, representation for Board of Medicine complaints, Drug Enforcement Administration (DEA) hearing defense attorney, DEA investigation attorney, Drug Enforcement Administration (DEA) hearing legal representation, Drug Enforcement Administration (DEA) investigation legal defense attorney representation, representation for DEA investigations against pharmacists and physicians, legal representation for pill mill allegations, legal representation for allegations of over prescribing, lawyer providing representation for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, defense for Drug Enforcement Administration (DEA) Order to Show Cause (OTSC), responding to Drug Enforcement Administration (DEA) Order to Show Cause (OTSC), Drug Enforcement Administration (DEA) Order to Show Cause (OTSC) attorney and legal defense

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” According to the U.S. Department of Justice (DOJ), all four allegedly dispensed controlled substances inappropriately, unlawfully and for non-medical reasons.

The Alleged Pill Mill.

The nurse practitioners and physician allegedly prescribed opioids including fentanyl, hydrocodone, oxycodone, methadone and hydromorphone on a monthly basis for years, according to the indictment. They then allegedly billed health care providers for related unnecessary patient examinations.

“[The four defendants] did knowingly and intentionally conspire to distribute and dispense and cause to be distributed and dispensed mixtures and substances containing detectable amounts of controlled substances by issuing and causing prescriptions for those substances outside the usual course of professional medical practice and for no legitimate medical purposes, through the operation of a pill mill,” the indictment stated.

Prosecutors alleged the medical personnel diagnosed patients at the Alabama practice with “vague, unsubstantiated medical conditions,” and prescribed controlled substances in 30-day quantities.

Additionally, prosecutors allege that they required the patients to have a follow-up appointment involving a physical examination that was “medically unnecessary.” They would then bill health care benefit programs for the patients’ visits, usually in the amount of $75, under allegedly false and fraudulent pretenses.

The alleged scheme earned the defendants more than $10,000. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. They face maximum sentences of 10 years in prison on the health care fraud counts.

To read the indictment in full, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.

According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions, including Show Cause Orders (SCOs) . The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings. It includes defense in federal or state court and defense in federal or state administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Robinson, Carol. “Alabama doctor, 3 nurse practitioners federally indicted in pill mill case.” AL.com (Alabama News). (December 5, 2017). Web.

Narea, Nicole. “Doctor, 3 Nurse Practitioners Charged With Running ‘Pill Mill’.” Law360. (December 5, 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for pain management clinic, pain management clinic defense attorney, Show Cause Order (SCO) defense attorney, Show Cause Order (SCO) defense legal counsel, Show Cause Order (SCO) defense lawyer, legal representation for over-billing, legal representation for submitting false claims, False Claims Act (FCA) defense attorney, medical license defense attorney, nursing license defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) defense counsel, Drug Enforcement Administration (DEA) defense lawyer, board of medicine attorney, board of pharmacy attorney, legal representation for Department of Health investigations, legal representation for allegations of over-prescribing, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” According to the U.S. Department of Justice (DOJ), all four allegedly dispensed controlled substances inappropriately, unlawfully and for non-medical reasons.

The Alleged Pill Mill.

The nurse practitioners and physician allegedly prescribed opioids including fentanyl, hydrocodone, oxycodone, methadone and hydromorphone on a monthly basis for years, according to the indictment. They then allegedly billed health care providers for related unnecessary patient examinations.

“[The four defendants] did knowingly and intentionally conspire to distribute and dispense and cause to be distributed and dispensed mixtures and substances containing detectable amounts of controlled substances by issuing and causing prescriptions for those substances outside the usual course of professional medical practice and for no legitimate medical purposes, through the operation of a pill mill,” the indictment stated.

Prosecutors alleged the medical personnel diagnosed patients at the Alabama practice with “vague, unsubstantiated medical conditions,” and prescribed controlled substances in 30-day quantities.

Additionally, prosecutors allege that they required the patients to have a follow-up appointment involving a physical examination that was “medically unnecessary.” They would then bill health care benefit programs for the patients’ visits, usually in the amount of $75, under allegedly false and fraudulent pretenses.

The alleged scheme earned the defendants more than $10,000. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. They face maximum sentences of 10 years in prison on the health care fraud counts.

To read the indictment in full, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.

According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions, including Show Cause Orders (SCOs) . The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings. It includes defense in federal or state court and defense in federal or state administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Robinson, Carol. “Alabama doctor, 3 nurse practitioners federally indicted in pill mill case.” AL.com (Alabama News). (December 5, 2017). Web.

Narea, Nicole. “Doctor, 3 Nurse Practitioners Charged With Running ‘Pill Mill’.” Law360. (December 5, 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for pain management clinic, pain management clinic defense attorney, Show Cause Order (SCO) defense attorney, Show Cause Order (SCO) defense legal counsel, Show Cause Order (SCO) defense lawyer, legal representation for over-billing, legal representation for submitting false claims, False Claims Act (FCA) defense attorney, medical license defense attorney, nursing license defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) defense counsel, Drug Enforcement Administration (DEA) defense lawyer, board of medicine attorney, board of pharmacy attorney, legal representation for Department of Health investigations, legal representation for allegations of over-prescribing, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” According to the U.S. Department of Justice (DOJ), all four allegedly dispensed controlled substances inappropriately, unlawfully and for non-medical reasons.

The Alleged Pill Mill.

The nurse practitioners and physician allegedly prescribed opioids including fentanyl, hydrocodone, oxycodone, methadone and hydromorphone on a monthly basis for years, according to the indictment. They then allegedly billed health care providers for related unnecessary patient examinations.

“[The four defendants] did knowingly and intentionally conspire to distribute and dispense and cause to be distributed and dispensed mixtures and substances containing detectable amounts of controlled substances by issuing and causing prescriptions for those substances outside the usual course of professional medical practice and for no legitimate medical purposes, through the operation of a pill mill,” the indictment stated.

Prosecutors alleged the medical personnel diagnosed patients at the Alabama practice with “vague, unsubstantiated medical conditions,” and prescribed controlled substances in 30-day quantities.

Additionally, prosecutors allege that they required the patients to have a follow-up appointment involving a physical examination that was “medically unnecessary.” They would then bill health care benefit programs for the patients’ visits, usually in the amount of $75, under allegedly false and fraudulent pretenses.

The alleged scheme earned the defendants more than $10,000. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. They face maximum sentences of 10 years in prison on the health care fraud counts.

To read the indictment in full, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.

According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions, including Show Cause Orders (SCOs) . The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings. It includes defense in federal or state court and defense in federal or state administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Robinson, Carol. “Alabama doctor, 3 nurse practitioners federally indicted in pill mill case.” AL.com (Alabama News). (December 5, 2017). Web.

Narea, Nicole. “Doctor, 3 Nurse Practitioners Charged With Running ‘Pill Mill’.” Law360. (December 5, 2017). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for pain management clinic, pain management clinic defense attorney, Show Cause Order (SCO) defense attorney, Show Cause Order (SCO) defense legal counsel, Show Cause Order (SCO) defense lawyer, legal representation for over-billing, legal representation for submitting false claims, False Claims Act (FCA) defense attorney, medical license defense attorney, nursing license defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) defense counsel, Drug Enforcement Administration (DEA) defense lawyer, board of medicine attorney, board of pharmacy attorney, legal representation for Department of Health investigations, legal representation for allegations of over-prescribing, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

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