High-dose opiates could draw fire from states, DEA
Even if local prosecutors pay little attention to the prescription of high-dose opiates for pain relief, others may have their interest piqued. Any contact from state regulatory bodies or federal drug agents may be enough to scare a doctor away from prescribing adequate pain relief, says Timothy Jost, JD, professor of law and health services management at The Ohio State University in Columbus.
State drug utilization review (DUR) programs monitor physician prescriptions to help guard against improper drug use, and they usually send inquiry letters to doctors who prescribe large quantities of narcotics. The letter is just the first contact, and evidence of legitimate reasons for the prescriptions can quickly end the DUR program’s interest. But when Jost studied the issue, he found that simply receiving the letter could cause some doctors to panic.
"As a nonmedical practitioner, these letters seem fairly nonthreatening to me, but if you’re a doctor already wary of government oversight, they could make you pretty skittish," Jost says. "Doctors don’t want any association with the idea that they’re handing out narcotics recklessly, so just getting the letter — or even fear of getting a letter like that — could discourage doctors from prescribing high doses."
Some states screen for high-dose patients
States have improved the way they manage such prescription oversight in recent years, he says. Some states, such as Ohio, now screen for patients with cancer or other conditions known to require high-dose opiates and avoid sending inquiries to doctors in those cases.
Doctors might be justifiably concerned when the state DUR program puts the spotlight on them, even if state regulators quickly conclude that the prescriptions were appropriate. The review process sometimes includes a notice to Medicaid and Medicare overseers, alerting them to possible fraud and abuse concerning the prescriptions.
Prescription can be red flag to DEA
The same can happen if the federal Drug Enforcement Administration gets wind of the inquiry and alerts federal fraud inspectors. In some cases, the original, legitimate prescription acts as a red flag that brings in inspectors who find totally different malfeasance.
"The narcotics prescription gets the attention, and then, once they’re in your office, they might find something irregular during an audit that can lead to fraud and abuse charges," Jost says. "The charges usually involve tests and visits related to the prescription that were billed but not actually done. In most cases, the problem is just that the doctor kept poor records."
The lesson, he says, is that high-dose opiate prescriptions indeed may result in increased attention from people the doctor would rather not hear from at all. It is imperative, therefore, that the supporting documentation be impeccable.
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