UNNECESSARY PROCEDURES… how many pts have been forced into getting ESI (Epidural Spinal Inj) in order to have the physician to write the a Rx for oral opiates,  when the ESI provide the pt little/no relief.  The FDA and the Pharma ( Upjohn) that makes the corticosteroid DOES NOT RECOMMEND that corticosteroids should be used in ESI.  There is already a couple of COUNTRIES that make those ESI ILLEGAL..  Apparently this hospital system didn’t get in trouble until a WHISTLE BLOWER that two surgeons were provided POOR CARE and care that was not appropriate (necessary).  Providing ESI involving corticosteroids and the pt doesn’t get any/much relief… then that is unnecessary medical care and billing insurance … is INSURANCE FRAUD.  It may also be a violation of a part of the Sherman Antitrust Act – called Tying commerce – where a person/entity is forced to buy something that they don’t want in order to be able to buy something that they do want.  Doesn’t that describe what happens when a practitioner REQURIES/FORCES a pt to have a EDI procedures involving corticosteroid in order to have  the practitioner to provide the pt a prescription for oral opiates ?

Health System on the Hook for $22M Over Unnecessary Spine Surgeries

https://www.medpagetoday.com/special-reports/exclusives/98247

Providence Health & Services agreed to pay $22.7 million to settle allegations that two of its neurosurgeons falsely billed federal healthcare programs for medically unnecessary spine surgeries, in the largest-ever healthcare fraud settlement in the Eastern District of Washington, according to the Department of Justice (DOJ).

The health system, the U.S. federal government, and the state of Washington reached a joint settlement Tuesday following a whistleblower complaint, which alleged that two spine surgeons employed at Providence St. Mary’s Medical Center in Walla Walla provided poor care and committed billing fraud from 2013 to 2018.

Providence, a large health system that has 51 hospitals in seven states, paid neurosurgeons based on a productivity metric, which gave them a financial incentive to perform more surgeries of greater complexity, the DOJ alleged. From 2014 to 2017, one of the surgeons in question earned between $2.5 and $2.9 million a year based on this metric, according to the settlement agreement.

The health system admitted that during the time period that the spine surgeons were employed, other medical staff expressed concerns that they endangered patients, performed surgeries that resulted in complications, conducted surgeries on patients when they were not appropriate, and did not adequately document their procedures.

Providence also acknowledged that while it did eventually place both of these surgeons on administrative leave, it allowed both doctors to resign while on leave, and did not take any action to report them to the National Practitioner Data Bank or the Washington State Department of Health.

“Ensuring that surgical procedures are medically appropriate and properly performed is critical to building safe and strong communities here in the Eastern District of Washington,” said U.S. Attorney Vanessa Waldref in a press release.

“Patients with back pain and spinal injury deserve top-notch care from a provider who puts the patient first and is not improperly influenced by how much he can bill for the procedure,” Waldref said. She added that Providence’s failure to ensure that its physicians were performing safe and necessary procedures, despite repeated warnings, “put patients’ lives and safety at serious risk.”

In a statement to MedPage Today, a spokesperson from Providence said that the events in question have prompted an internal investigation of policies, practices, and procedures to ensure the delivery of high-quality care.

“We are committed to taking specific, concrete actions to ensure this isolated incident in Walla Walla does not happen again,” the spokesperson stated. “Providence has strong existing protocols and safeguards to ensure we deliver quality care and make continuous improvements that further enhance those protocols and safeguards.”

In January 2020, a whistleblower had filed a complaint stating that two spine surgeons at Providence St. Mary’s Medical Center — Dan Elskens, MD, and Jason Dreyer, DO — provided substandard care from 2013 to 2018. Elskens and Dreyer were not named in the settlement agreement.

The whistleblower, also a neurosurgeon, had found that Elskens committed several surgical errors upon an internal review, the complaint stated, including operating on incorrect spinal sections requiring emergency remedial surgery.

The whistleblower allegedly reported these concerns to Providence’s chief medical officer, recommending that Elskens be terminated. However, Providence rejected that initial recommendation. The whistleblower then discovered that Elskens allegedly botched an additional surgery — nearly paralyzing the patient — before Providence placed Elskens on a suspension.

During this time, the whistleblower also began to review the work of Dreyer, who studied under Elskens. His review found that Providence billed the federal government for procedures that Dreyer never performed. In addition, he complained that Dreyer was “fabricating patient diagnoses and treatments to justify complex operations and to increase the reimbursement of both himself and Providence.”

Some of the incidents caused the federal government to pay amounts exceeding $150,000 for unnecessary and underperformed procedures, the complaint stated. The whistleblower reported these concerns in November 2017 and again in May 2018 before Providence suspended Dreyer, they alleged.

Both Elskens and Dreyer resigned during their suspensions, according to the complaint. Elskens’ medical license has been restricted in Washington and Michigan, but remains active in Indiana and Ohio. Dreyer’s medical license remains active in Washington and Michigan, and no actions have been taken by state medical boards.

The whistleblower will receive approximately $4 million as a result of the settlement.

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I find it very interesting that the “expert” ( Andrew Kolodny) for the plaintiff  “broke down how HE BELIEVES that the companies named – among others – collaborated in the 1980’s and 1990’s to increase prescriptions for opioids across America  and ESPECIALLY IN WEST VIRGINIA.”

So the plaintiff appears to be totally counting on and basing their case on the OPINION of this “expert”.  My understanding is that any measurable perceived “opiate crisis” did not really again any traction until after Purdue Pharma introduced Oxycontin – which wasn’t until 1995-1996 and another potential stimuli was the Decade of Pain Law that was passed and signed into law in 2000.

Generic Vicodin first became available in 1983 and typically once a pharma loses a patent on a brand name med and the generic becomes available. The pharma does less promotion of the brand name, because most all states have mandatory generic substitution – unless brand name is specified by the prescriber, but most PBM/insurance will not pay for the brand name and/or charge a very large copay when a brand name is dispensed when a generic is available.

If there was few/no brand name opiates without a generic available. Historically, there is little/no promotion of a brand name opiates being promoted directly to prescribers.. the number of Rxs being prescribed will generally “fall off”. Pharmas making generics typically do not support a marketing staff to call on prescribers. The marketing to physicians is a very expensive endeavor and generic pharmas not have the profit margins to support a marketing staff.

This newspaper article did not elaborate on what was entailed in Kolodny’s “broke down how he believes the companies collaborated “

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Hello,

When a pharmacist thinks that holding a pt’s medication as hostage because – according to their calculation – they pt should have a few doses still on hand.  So the pt is suppose to just believe that the Pharmacist did not make some math errors in their calculation ? I wonder if these are the same pharmacist’s “mindset” that when they require the pt to wait until they are ready to take their last dose from the previous fill and they are out of stock of their meds… and they have no concerns that they won’t be able to get the pt’s med back in stock for several days…  I am sure that the pharmacist has no idea of what is in like for a chronic pain pt to be thrown into cold turkey withdrawal and maybe into a torturous level of pain…  maybe miss a couple of days of work… 

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Steve do you know . . .Has anyone ever had issues with receiving less meds than MD ordered? How did you handle it? My insurance only pays at Walgreens. Must wait until next year to change it. It’s not like I can confront the pharmacy without being called suspicious and med seeking.  It would probably raise my narxcare score. They are rude enough to my family when they pick up meds as it is. My family used to ask for a count before leaving the counter, but with lay offs, short staffing, shorter hours, no weekend hours they won’t take the time to do it, unless my friend has floated over from another store. A days worth is bad enuf, but a week??&%$#@. I asked the group at American pain and disability. Got some suggestions.

They have a typed letter taped to counter that staffing issues are prohibitive to counting meds again when a patient picks them up.

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Matching drugs to DNA is ‘new era of medicine’

https://www.bbc.com/news/health-60903839

Image source, Jane Burns

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This video appears to be a video made by a parent of a 16 y/o that had back surgery and the surgery was done in the Duke University healthcare system. I had a heard a couple of years ago that Duke U had implemented a little/no opiate policy.

I can’t imagine a surgeon only willing to talk to a 16 y/o pt and won’t speak with the Mother. And according to this Mother the surgeon – or someone from the staff – would return a call after a couple of days from leaving a VM.

I suspect that if a parent – or anyone – intentionally inflicted pain or harm a child, I would expect that child protective services or cops would be looking for them… but… medical professionals seems to be exempt from being held responsible for a child being intentionally abused.

When is our society going to stop accepting/tolerating that pts being intentionally put in or left in pain without any consequences.. At least back in the 19th century, pts got a tree branch to chew on and bottle of WHISKEY.

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We opened our independent pharmacy in 1976, back then the PBM industry was a minor part of paying for prescriptions, the vast majority of prescriptions were paid by cash/check/credit card.

In the early 80’s as the DRG reimbursement was implemented in the hospital system. Basically, when a person was admitted to a hospital, the hospital was given a fixed $$$ based on the pt’s diagnose and if the hospital spent less than the budgeted $$$ they made money… if they spend more than the budgeted $$$ the hospital LOSS MONEY.

The phrase quickly coined discharged “quicker and sicker”… The need/demand for various hospital equipment for the pt recuperating at home grew dramatically.  So we began being a supplier for home medical equipment.  Providing hospital beds, wheelchairs, walkers, crutches/canes, bedside commodes and the like.

As we got requests for items we did not normally stock, we expanded into new areas including home oxygen and related respiratory equipment & supplies, Home IV’s, Enteral feedings, T.E.N.S unit and both Barb and I got certified as prosthetic and orthotic fitters. Which allowed us to provide custom fitted back braces and Jobst custom compression stockings. Eventually we expanded adding a Mastectomy Center and Barb became our master fitter/trainer for women who had breast cancer and mastectomy surgery.

We had moved from our little 1200 -1400 sq ft pharmacy to a 5000 sq ft pharmacy, home medical equipment and Mastectomy center and a off site 2800 sq ft warehouse.  We went from a one pharmacist and one full time and one part time pharmacy tech to a total staff of 18 employees.

We also moved from being primarily a cash/check/credit card business to one doing a great deal of billing to Medicare part B, Medicaid and numerous other insurance companies.  To survive, we had  to become experts in billing and dealing with all the different rules and regulations of all those various insurance entities.

During those years, we went to DC with two of national associations that we belonged to… when they had multi day legislative meetings and we would meet with our elected members of the House and the Senate to lobby them on some legislative changes that was up for discussion and changes to regulation that affected our business and the pts that we cared for.

What was pretty common is that – especially large – proposed changes would not be addressed or final posting would not happen until after Labor Day on years when there was a Federal Election.  They would finalize the proposed rules then because all 435 members of the House and 33-34 members of the Senate would be out on the CAMPAIGN TRAIL…  When the election was over the first week of Nov… Congress would come back to DC…  those that did not get re-elected would start packing their office up… those who gained seniority because of the election would start jockeying for new/better office based on their new seniority.

Before you know it… it is time for Congress’ Christmas break…  before the new Congressional session starts the first of Jan.. Then there is orientation for the new ‘freshman” members of Congress. So the bureaucrats have several months to implement their proposed regulation changes to implement… because no one in Congress is around to try to get them to intervene.

If history repeats itself, the CDC will finalize the 2022 proposed opiate dosing guidelines around Labor Day and the DEA will latch on to them and start their indoctrination of various entities that have DEA licenses to prescriber or dispense controlled meds and most likely, they will have been working on their “new standard of care and best practices” to start their intimidation of many as possible within the healthcare system… that 50 MME/day is – IN THEIR OPINION – is where a prescriber prescribing greater than 50 MME/day will constitute providing opiates outside of “valid medical need” – per the DEA’s medical expertise

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Tennessee governor won’t consider clemency for RaDonda Vaught

https://www.beckershospitalreview.com/legal-regulatory-issues/tennessee-governor-won-t-consider-clemency-for-radonda-vaught.html

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It would seems that the Federal bureaucracy gets more and more contradictory… a number of years ago our Supreme Court ruled that the 8th Amendment only applies to prisoners

Treatment for opioid addiction often brings discrimination

https://apnews.com/article/covid-business-health-opioids-discrimination-5462560a707d7c27b71ed4773d9ba82c

PHILADELPHIA (AP) — Danielle Russell was in the emergency department at an Arizona hospital last fall, sick with COVID-19, when she made the mistake of answering completely when she was asked what medications she was on.

“I said yes, I was taking methadone,” said Russell, a doctoral student who also was in recovery from heroin use. “The smart thing to do, if I wanted to be treated like a human, would be to say no.”

Even though her primary doctor had sent her to the ER, she said she was discharged swiftly without being treated and given a stack of papers about the hospital’s policies for prescribing pain medications — drugs she was not asking for.

“It becomes so absurd and the stigma against methadone especially is so strong,” she said, noting that other people in recovery have had it worse. “You’re getting blocked out from housing resources, employment.”

It’s a problem people in the addiction recovery community have dealt with for decades: On top of the stigma surrounding addiction, people who are in medical treatment for substance abuse can face additional discrimination — including in medical and legal settings that are supposed to help.

This week, the U.S. Department of Justice published new guidelines aimed at dealing with the problem: They assert that it’s illegal under the Americans with Disabilities Act to discriminate against people because they are using prescribed methadone or other medications to treat opioid use disorder.

The guidelines don’t change federal government policy, but they do offer clarification and signal that authorities are watching for discrimination in a wide range of settings. The Justice Department’s actions this year also show it’s taken an interest in the issue, reaching multiple legal settlements, filing a lawsuit and sending a warning letter alleging other violations.

One of the government’s recent settlements was with a Colorado program that helps house and employ people who are homeless. A potential client filed a complaint claiming she was denied admission because she uses buprenorphine to treat her addiction. As part of the settlement, Ready to Work is paying the woman $7,500. Stan Garnett, a lawyer for the organization, said Thursday that the organization’s staff is being trained to comply with the law.

FILE – In this Nov. 14, 2019, photo, Jon Combes holds his bottle of buprenorphine, a medicine that prevents withdrawal sickness in people trying to stop using opiates, as he prepares to take a dose in a clinic in Olympia, Wash. The U.S. Department of Justice made clear, Tuesday, April 2, 2022, that barring the use of medication treatment for opioid abuse is a violation of federal law. (AP Photo/Ted S. Warren, File)

PHILADELPHIA (AP) — Danielle Russell was in the emergency department at an Arizona hospital last fall, sick with COVID-19, when she made the mistake of answering completely when she was asked what medications she was on.

“I said yes, I was taking methadone,” said Russell, a doctoral student who also was in recovery from heroin use. “The smart thing to do, if I wanted to be treated like a human, would be to say no.”

Even though her primary doctor had sent her to the ER, she said she was discharged swiftly without being treated and given a stack of papers about the hospital’s policies for prescribing pain medications — drugs she was not asking for.

“It becomes so absurd and the stigma against methadone especially is so strong,” she said, noting that other people in recovery have had it worse. “You’re getting blocked out from housing resources, employment.”

It’s a problem people in the addiction recovery community have dealt with for decades: On top of the stigma surrounding addiction, people who are in medical treatment for substance abuse can face additional discrimination — including in medical and legal settings that are supposed to help.

This week, the U.S. Department of Justice published new guidelines aimed at dealing with the problem: They assert that it’s illegal under the Americans with Disabilities Act to discriminate against people because they are using prescribed methadone or other medications to treat opioid use disorder.

The guidelines don’t change federal government policy, but they do offer clarification and signal that authorities are watching for discrimination in a wide range of settings. The Justice Department’s actions this year also show it’s taken an interest in the issue, reaching multiple legal settlements, filing a lawsuit and sending a warning letter alleging other violations.

One of the government’s recent settlements was with a Colorado program that helps house and employ people who are homeless. A potential client filed a complaint claiming she was denied admission because she uses buprenorphine to treat her addiction. As part of the settlement, Ready to Work is paying the woman $7,500. Stan Garnett, a lawyer for the organization, said Thursday that the organization’s staff is being trained to comply with the law.

“It’s terrifying to be told by some authority — whether it’s a judge, or a child welfare official, or a skilled nursing facility — someone who has something you need is telling you you have to get off the medication that is saving your life,” said Sally Friedman, senior vice president of legal advocacy at the Legal Action Center, which uses legal challenges to try to end punitive measures for people with health conditions, including addiction.

Friedman said advocates and lawyers will cite the new guidelines when they’re making discrimination claims.

Dan Haight, president of The LCADA Way, which runs addiction treatment programs in the Cleveland area, said a suburb where they wanted to put a clinic at one point nixed the idea because of a moratorium in place on new drug counseling centers.

“We’re not looked at as another medical facility or counseling office,” Haight said. “We’re looked at because we do addiction.”

The new guidelines suggest that such broad denials could be violations of the ADA.

Overdoses from all opioids, including prescription drugs containing oxycodone, heroin and illicit laboratory-made varieties including fentanyl, have killed more than 500,000 Americans in the last two decades, and the problem has been growing only worse. That has frustrated advocates, treatment providers and public health experts who see the deaths as preventable with treatment.

Even as the crisis has deepened, there have been glimmers of hope. Drugmakers, distribution companies and pharmacy chains have announced settlements since last year to pay government entities about $35 billion over time plus provide drugs to treat addictions and reverse overdoses. Most of the money is required to be used to fight the epidemic.

It’s still to be determined how the money will be deployed, but one priority for many public health experts is expanding access to medication-based treatments, which are seen as essential to helping people recover.

But there’s still a stigma associated with the treatment programs, which use the medication naltrexone or drugs that themselves are opioids, such as methadone and buprenorphine.

Marcus Buchanan used methadone from 2016 through 2018 to help end a decadelong heroin habit. During that time, he was looking for work near his home in Chouteau, Oklahoma — mostly at factories — and could never land one.

“I can nail an interview. It would be the drug-screen process” when he’d explain why the results showed he was using methadone, said Buchanan, who is now an outreach coordinator for an opioid prevention program. “Every job, more than 20 probably, during those two years, was a door shut in the face.”

Dr. Susan Bissett, president of the nonprofit West Virginia Drug Intervention Institute, said people who are in treatment programs often hide it out of fear that they could lose their jobs.

She said she wants to reach out to business leaders and encourage them to hire and retain people who are using the medications.

“The next step is helping employers understand this is a disease instead of a moral failing,” Bissett said. “We don’t think about substance abuse disorder the way we think about diabetes, for example.”

One of the places where medication-assisted treatment is sometimes restricted or banned is in state drug diversion court programs, which are intended to get people help for addiction rather than incarcerate them.

Fewer than half the states have specific language that prohibits judges from excluding people who are taking the medications from participating in diversion programs or requires that they allow its use as part of the programs. That finding is based on an Associated Press review of legislation, administrative court orders and drug court handbooks that guide state drug diversion court programs.

Some states allow individual courts to make their own rules, while others only include language saying people can’t be excluded. Judges in some states still require defendants to taper off the medications and allow the diversion programs to decide whether the medications are appropriate for each person enrolled.

The Center for Court Innovation is trying to steer the drug courts into creating policies and programs that support people taking those medications instead of incentivizing them to stop.

“It can be frustrating, because nobody needs to tell a judge they need to allow someone to take blood pressure medication,” said Sheila McCarthy, a senior program manager for the Center for Court Innovation. “But for some, there is just a disconnect about the real effect these medications have on a person’s daily life.”

Veronica Pacheco has been off methadone for nearly a year after being on it for more than six years to treat an addiction to pain pills.

She said some people in the medical field — a physician, a dentist, a pharmacist — seemed to treat her differently after they learned she was on methadone treatment. They sometimes assume she was going to ask for new prescriptions for pain medications.

“I felt like I had a sign on my forehead saying, ‘I am a methadone person.’ The minute someone has your medical record, everything changes,” said Pacheco, who lives in the Minneapolis suburb of Dayton. “Now that I’ve been off it, I can see the night-and-day difference.”

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