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Lost Years and Lives: Prescription Drug Abuse

Prescription narcotic drugs

Most of us are reluctant to take medicine, but we do so when such is truly needed to protect our health and, even then, only as directed by a trusted physician. However, others in our society – often our friends, neighbors and family members – are alarmingly, increasingly abusing and misusing narcotics prescribed by a medical provider. These highly addictive drugs are, by law and all good reason, “controlled” substances because they can negatively affect a patient’s quality of life, and may lead to death. Sadly, some individuals, including claimants, are committing crimes to obtain drugs. Some are illegally diverting their drugs to others. The scope of this national concern is quite significant here in Ohio.

Fast Facts — BWC Prescription drug statistics for 2010:

  • Claimants received more than $130 million in prescription drugs;
  • Oxycontin accounted for nearly $20 million of the prescription drug costs; and
  • More than 50,000 claimants received prescription narcotic drugs.

Drug Deception: Claimants criminally deceive their honest medical provider to obtain prescriptions. Claimants exaggerate symptoms or fabricate their conditions to cause their medical provider to prescribe drugs to them. For example, some claimants repeatedly file claims at emergency rooms to obtain narcotics. Claimants alter prescriptions to increase prescribed pill count, dosage or strength. Claimants criminally deceive pharmacists to fill prescriptions. Claimants falsify prescriptions, sometimes making copies of a valid prescription or stealing a blank prescription to complete as they will and forging the signature of a medical provider.

Drug Diversion: Some claimants illegally divert their prescribed narcotics to others. The street value of these narcotics can often be 10 times the cost of such to BWC. These “claimants turned drug dealers” sell their pills out of their homes, on the street, or at our schools. They also barter their pills for services, some of which are also illegal. The frequency and magnitude of this criminal behavior cannot be over-stated. In an article, May 21, 2011, entitled “Kasich signs ‘pill mill’ bill,” the Columbus Dispatch reported the Ohio State Patrol “…confiscated 20,219 pills from Jan. 1 through May 10 [2011]. The agency also made 1,979 drug-related arrests through April, a 6 percent increase from the first four months in 2010.”

Doctor Shopping: Claimants criminally deceive multiple medical providers to obtain multiple, often redundant, prescriptions. Some claimants seek and secure treatment from multiple medical providers. Here, the claimant deceives each medical provider, causing them to believe the claimant is receiving treatments and prescriptions exclusively from them. These claimants shop medical providers until they find those that they can successfully deceive. When an effective medical provider challenges the claimant, he/she simply moves on to another prospective medical provider.

A Case In Point

The SID Intelligence Unit detected a claimant had filled prescriptions written by eight physicians for nine narcotics overlapping during an eleven month period of time. Our investigation found the claimant had deceived physicians in order to obtain the narcotic prescriptions. When furnished proof of the claimant’s actual drug use, the physicians stated in writing the claimant had deceived them by failing to disclose his treatment by other physicians. The physicians documented they would not have prescribed narcotics for the claimant had they known of his doctor shopping.

The subject pled guilty to one count of deception to obtain dangerous drugs, a fifth-degree felony. The court sentenced the subject to serve 12 months of incarceration (suspended) and two years of community control, and suspended his driver’s license for six months. The court ordered the subject to pay court costs.

Effective Strategic Responses: Each month our SID Intelligence Unit reviews data pertaining to all claimants receiving BWC-paid prescriptions and refers claims to field operations for review and determination, including scheduling physicians to review the appropriateness of prescribed drugs to treat a claimant’s allowed conditions. Since March 2008, these reviews have resulted in the termination of drugs in 1,666 cases, generating $39.7 million in savings to the Ohio workers’ compensation system. We are increasingly deploying significant resources to conduct joint investigations with federal, state and local law enforcement agencies to combat prescription fraud. For example, our department is a member of the Ohio Governor’s Opiate Drug Task Force.

We work with the BWC pharmacy department, established in 2009, to address issues related to the BWC drug program. During FY 2011, the pharmacy department enacted several changes. We assisted the pharmacy department with several innovations. For example, we are pursuing a rule change that no longer requires BWC to pay for prescriptions written by decertified or non-enrolled providers. Additionally, the BWC Board of Directors approved BWC’s first ever formulary of medications for the outpatient treatment of claimants. Formularies are an industry standard that improve quality of care by enhancing the effectiveness and safety of the medications prescribed to Ohio’s claimants. Our drug formulary will improve treatment and limit the inappropriate use of medications and reduce prescription costs. We are also seeking a rule change that will allow BWC to designate a single pharmacy and/or a single prescribing physician to a given claimant.

Each of these strategies ensures the agency balances good patient care with fiscal responsibility and effectively responds to the dramatic increase in accidental deaths associated with the use of prescription narcotic drugs.

Be on the Lookout

Red flags that may indicate a claimant may be committing deception to obtain a dangerous drug or diverting their narcotic prescriptions by selling or giving them to others:

  • A claimant brags about being able to secure any drugs they want from a “friendly” physician;
  • A claimant is suspected of receiving treatment and/or prescriptions from multiple physicians;
  • A claimant repeatedly files claims at emergency rooms to obtain narcotic;
  • A claimant is suspected of being addicted to narcotics and/or other drugs; and
  • A claimant is suspected of selling narcotics and/or other drugs.

If you suspect anyone is fraudulently receiving the benefits of a deceased claimant, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

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