Breakthrough

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69066886 - non-proprietary medicine prescription bottles and spilled pills abstract with stethoscope.

According to the National Cancer Institute, there were 15.5 million cancer survivors living in the United States in 2016. About 40 percent of those survivors deal with chronic pain related to their cancer treatment. Even though opioid medications can be highly addictive, doctors commonly prescribe the narcotics to treat individuals suffering from pain caused by cancer. Today, we take a look at a physician’s assistant (PA) from Dover, New Hampshire who committed Medicare fraud by receiving cash kickbacks for overprescribing unnecessary opioids to patients who didn’t want them.

Today’s fraudster was motivated by greed after being approached by a representative of a drug manufacturer. (The drug rep made an offer the former PA could not refuse.) The PA was promised cash kickbacks for prescribing fentanyl spray, an FDA-approved drug used to treat breakthrough cancer pain. For over more than a year, the PA wrote more than 750 prescriptions for the fentanyl spray throughout the State of New Hampshire. Approximately 225 of those prescriptions were issued to Medicare patients. While Medicare got stuck with a bill totaling $2.1 million for the opioid spray prescriptions, the PA made off with $49,000 – about $1,000 per event – for speaking as a representative of the drug manufacturer at more than 40 “sham” events. These events were basically dinners with employees or representatives of the pharmaceutical company. (The PA got some nice meals while his patients became addicted to the spray.)

The fraud article states that the PA started many of his patients off on high doses of the fentanyl spray. (That’s so they would become addicted to the substance and require more.) He kept prescribing the medication despite pleas from his patients and their family members who expressed that the drug was no longer wanted. (Some of his patients didn’t even need the medication.)

The 44-year-old New Hampshire man who worked at a Dover pain clinic was charged with eight crimes for prescribing an addictive fentanyl spray in exchange for cash kickbacks. Following a week-long trial, he was convicted of Medicare fraud and faces up to 40 years in prison when sentenced.

As you might guess, some of the patients affected by the fraudster’s gross negligence are going after the drug manufacturer seeking damages. Read this article to find out more about one of the fraudster’s patients who became highly dependent upon a high dosage of the drug. (The drug was so strong, it left her unconscious at one point and she asked to have her dosage decreased. The PA didn’t immediately honor her request.) The bottom line is that healthcare providers such as today’s PA should be making sound decisions based on their patients’ conditions, not what’s best for their bank account. Here’s hoping the extremely deceptive PA has a breakthrough of his own where he can finally understand how much pain he has caused for his vulnerable victims.

Today’s “Fraud of the Day” is based on an article entitled, “Physician’s assistant guilty in Subsys kickbacks case,” posted on fosters.com on December 18, 2018.

CONCORD — A federal jury on Tuesday found a former physician’s assistant “guilty of participating in a scheme in which he received kickbacks in exchange for prescribing a powerful fentanyl spray to patients in violation of federal law,” announced U.S. Attorney Scott W. Murray.

Christopher Clough, 44, of Dover, was charged with eight crimes alleging he prescribed the addictive fentanyl spray Subsys, in exchange for cash kickbacks, while working at a Dover pain clinic. After a week of trial testimony and the guilty verdict, Murray announced, Clough “often prescribed the drug for patients who did not have breakthrough cancer pain. He often started patients on high doses of the addictive fentanyl spray and rebuffed patients and their family members who stated that they no longer wanted the drug.”

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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.