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Dept of Justice Opioid Fraud and Abuse Detection Unit - First Post About This.

Greetings from Steve Meister and Shuli Suman, owners and co-founders of ScripRight Healthcare Consultants, LLC.  In this post and several more to come, we are focusing on a   fundamentally important development out of the US Department of Justice.  The Department earlier this month announced the creation of an Opioid Fraud and Abuse Detection Unit.  This is one of the most important things ever to come out of DOJ about the prescription drug crisis.

DOJ will form 12 teams of prosecutors and federal agents (DEA, FBI, Health and Human Services, etc) to work exclusively out of 12 federal court districts around the country, coast to coast.  All regions of the nation will house a prosecutorial team.  These prosecutors and agents will be dedicated to opening investigations, targeting doctors, hospitals, pharmacists and other providers, and prosecuting healthcare professionals for prescribing related crimes.

We at ScripRight have long taught that Medicare/Medicaid and health insurance carriers are using years and years of mountains and mountains of billing data to target doctors, hospitals and others in healthcare for investigation and prosecution, for fraud, inappropriate prescribing and abuse.  Now, it is public and official Department of Justice policy!

The 12 teams of prosecutors and law enforcement agents in the Opioid Fraud and Abuse Detection Unit will use highly sophisticated data analytics (and they will be hiring outside contractors to help, for lots and lots of federal dollars) to find fraud, waste and abuse in healthcare related to opioid prescribing.  They will be able to look for whatever information they want in the data, and we should expect them to try and be as innovative and creative as they can in finding ways to figure out whether prescriptions are legal or illegal, appropriate or excessive, and whether the government or private insurers are being legitimately or improperly billed for prescription-related medical care.

This is The New Order when it comes to investigating doctors, hospitals, pharmacists and others for possible prescribing-related crimes and violations.  Imagine how much time and effort agents and prosecutors will save by using data to INITIATE investigations, instead of the old way of waiting for a tip – or a 911 call about an overdose – and trying to figure things out from the ground up.

More posts to come from us on this.  We hope you’ll read them and reach out to us with comments or questions!

Steve and Shuli

ScripRight Healthcare Consultants, LLC