Drowning in Pills

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11941577 - pills and money - business medical background

According to the Centers for Disease Control and Prevention, opioid prescriptions are linked to more than 40 percent of all U.S. opioid overdose deaths. (More than 200,000 people died from prescription opioid overdoses between 1999 and 2016. Just during 2016, more than 46 people died each day as a result of prescription opioids.) A Hazard, Kentucky doctor was recently convicted of healthcare fraud for improperly prescribing pain pills in an area with a high incidence of drug problems.

For more than eight years, the doctor contributed to the opioid overdose epidemic in Southeastern Kentucky by distributing millions of pain pills through his clinic and by ordering unnecessary medical tests. (The doctor’s office scheduled multiple patients for the same time slots so he could move lots of patients along his fraud machine assembly line.) The doctor pre-signed opioid prescriptions for other employees to give out when he was not in the clinic. Then he authorized billing Medicare and Medicaid for $87.9 million. (Subsequently, $21.1 million was paid either to the clinic or to other providers referred by the doctor.)

The pain pill epidemic fraud scheme was not carried out solely by the doctor. His wife, who was listed as the president at the clinic, also had a hand in perpetrating the scheme. (Instead of throwing out a life raft, she was also credited with helping patients to drown in millions of pain pills.) The judge in the case ruled that while the clinic did provide legitimate medical care to some of their patients, 60 percent of the billing was fraudulent.

In court, the wife’s attorney tried to paint her as a loving mother who volunteered at her children’s school, church and in the community. (While the lawyer sought only a three-year sentence, the judge didn’t buy it.) The 52-year-old wife was convicted of healthcare fraud and sentenced to six years and eight months in jail.

The 52-year-old doctor’s attorney asked for a 10-year sentence, describing the defendant as a caring physician who provided quality care to his patients. (Uh, are you kidding me?) The judge didn’t buy the lawyer’s argument either and sentenced him to 15 years behind bars after being convicted on more than 150 charges of healthcare fraud. It is possible that the husband and wife could be ordered to pay more than $12 million in restitution; however, the doctor’s attorney stated he has no assets. (I’m guessing he thought he might be caught one day, so he hid his assets.)

This former physician, who took an oath to “do no harm” to his patients, did the exact opposite. His greed for profit drove him to defraud taxpayer-funded health programs by doling out prescriptions for pain pills in an area of the country that was already drowning in addiction. Now that he is barred from resuming his deadly scheme over the next 15 years while in prison, let’s hope that his former patients will reach for a lifeline to pull them out of their deadly addictions.

Today’s “Fraud of the Day” is based on an article entitled, “This couple helped drown Eastern Kentucky in pain pills. Now they’re going to prison.,” published by Lexington Herald Leader on September 30, 2017.

A Perry County physician convicted of defrauding taxpayer-funded health programs and of improperly prescribing pain pills in an area awash in drug problems should serve 15 years in prison, a federal judge ruled Thursday.

James Alvin “Ace” Chaney, 52, was convicted on more than 150 charges that included improper prescribing and billing Medicare and Medicaid for unnecessary tests between March 2006 and October 2014.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.