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Landmark Mental Health Ruling Finds Top Insurer Illegally Denied Patients Coverage

Mental health patients in the U.S. scored major victory when a federal judge issued a landmark ruling against the nation’s largest health insurer, finding that it has been illegally denying coverage to policyholders seeking treatment for mental health and substance abuse. United Behavioral Health, a unit of UnitedHealthcare, “deviated” from national health care standards by implementing cost-cutting policies that effectively deprived mental health patients of access to critical, life-saving treatments, U.S. Chief Magistrate Judge Joseph Spero found. He also suggested that the company was more intent on feeding its bottom line than providing adequate and appropriate coverage to mental health ... Read More

Thousands of Illegal Opioid Prescriptions Dispensed by Houston Clinic

After a Houston clinic owner and physician went to prison for writing thousands of fraudulent prescriptions for opioid painkillers and other prescription drugs, Drug Enforcement Administration (DEA) agents shared with the press some of the clinic’s inner workings to demonstrate how insidious the opioid epidemic has become. Houston’s KPRC-TV featured the case of Gulfton Community Health Center, which ran an illegal opioid distribution operation that dispensed about 34,000 illegal prescriptions (about 2.1 million units of hydrocodone alone) to opioid addicts and dealers. DEA agent Wendell Campbell told KPRC that agents usually saw lines of 30-40 people at the doors of ... Read More

Florida Opioid Pill Mill Doctor, Staff Go to Prison

A South Florida doctor busted for illegally dispensing prescription opioid painkillers to cash-paying “patients” has been sentenced to six-and-a-half years in prison. Dr. Andres Mecia, 64, of Fort Lauderdale, ran an opioid pill mill in his Oakland Park, Florida clinic, Adult & Geriatric Institute of Florida Inc., which operated under the name AGI Medical & Dental. According to the government’s allegations, Dr. Mencia and office personnel — Oscar Luis Ventura-Rodriguez, 41, of Ft. Lauderdale; Nadira Sampath-Grant, 51, of Margate, and John Mensah, 50, of Miami, performed sham consultations with patients seeking opioid drugs. In these consultations, Dr. Mencia and his co-conspirators ... Read More

U.S. Fights Opioid Epidemic With New Newark/Philadelphia Strike Force

The federal government is expanding its efforts to combat the nation’s opioid crisis and health care fraud with a new regional Medicare Fraud Strike Force operation for the Newark and Philadelphia areas. The Newark/Philadelphia Medicare Strike Force location is the tenth region-specific operation. All of the Strike Force locations monitor health care activity in a specific region for fraud affecting government health care programs. The growing crisis of opioid abuse and addiction has not just harmed tens of thousands of individuals and their families across the U.S., it has also taken its toll on the Medicare program, which loses billions ... Read More

Propelled by Fraud, Opioid Overdose Soars To New Levels

The opioid crisis is on a disturbingly sharp upward trend across the U.S. despite the federal government’s tough talk and costly crackdown efforts, according to a new report from the Centers for Disease Control and Prevention (CDC). From July 2016 through September 2017, emergency hospital visits due to opioid overdose rocketed 30 percent overall and 35 percent in the 16 states hardest hit by the opioid epidemic, according to the CDC. “We have an emergency on our hands,” said acting CDC Director Anne Schuchat, according to NPR. “The fast-moving opioid overdose epidemic continues and is accelerating.” The U.S. Department of Justice ... Read More

West Virginia’s Opioid Crisis The Focus of Congressional Investigation

The opioid epidemic in West Virginia is a focus of a Congressional investigation seeking to determine why three major opioid distributors flooded the state with more than 780 million hydrocodone and oxycontin painkillers in a recent six-year period – about 433 opioid pills for every West Virginia resident. According to The (Huntington, West Virginia) Herald-Dispatch, the U.S. House Committee on Energy & Commerce had mailed inquiries to drug distributors McKesson, Cardinal Health, and AmerisourceBergen looking for answers about their involvement in opioid pill dumping in the state. The inquiries, which The Herald-Dispatch says present more than 70 questions and 40 ... Read More

Las Vegas Doctor Arrested For Illegal Opioid Distribution

A Las Vegas pain management physician was arrested Tuesday, Feb. 13, and charged with 29 counts of unlawful distribution of a potent opioid drug and health care fraud. The U.S. Justice Department (DOJ) said it leveled the charges against Dr. Steven A. Holper, 66. Seven of the 29 charges allege the doctor prescribed the opioid Subsys (fentanyl sublingual spray), outside his professional practice to people who had no medical need for the drug. According to the DOJ, Dr. Holper “routinely prescribed Subsys for his patients without cancer.” The remaining charges involve Dr. Holper’s alleged false statements to Medicare and private health ... Read More

‘Cheerleaders for Opioids’ Paid by Drug Makers

The top five manufacturers of opioid drugs set the stage for the nation’s epidemic of opioid abuse and addiction by investing millions of dollars into certain advocacy groups that aggressively promoted use of the highly addictive painkillers, a U.S. Senate committee investigation determined. The Senate Homeland Security and Governmental Affairs Committee investigation, spearheaded by Sen. Claire McCaskill (D-Missouri), examined the financial ties between the nation’s leading opioid manufacturers and outside organizations, such as patient advocacy groups, professional medical societies, and pain management awareness associations. Sen. McCaskill concluded that the opioid manufacturers invested more than $10 million into these groups, which ... Read More

Feds Ramp Up Efforts To Combat Opioid Fraud

As the nation’s opioid crisis continues to deepen, federal law enforcement authorities are concentrating their efforts on doctors and pharmacies that prescribe and dispense unusually large and disproportionate quantities of prescription opioid painkillers. Speaking at the U.S. Attorney’s office in Louisville, Kentucky, U.S. Attorney General Jeff Sessions said U.S. Drug Enforcement Administration (DEA) agents have launched a 45-day focused effort to gather and analyze opioid prescription and dispensing data. The patterns and statistical outliers that this data reveals will help DEA agents and other law enforcement authorities identify and crack down on the doctors and practices that are overprescribing and ... Read More

Nevada Cardiologist Arrested For Peddling Opioids, Health care Fraud

Federal authorities arrested a Nevada cardiologist Dec. 12 on dozens of charges related to the unlawful distribution of prescription opioids and health care fraud. Dr. Devendrakumar I. Patel, 58, faces 36 counts of distribution of controlled substances, including fentanyl, hydrocodone, and oxycodone, and three counts of health care fraud for allegedly billing Medicare and Medicaid for costly tests that he never provided. Dr. Patel is a cardiologist at Northeastern Nevada Cardiology in Elko, a practice that he owns. Dr. Patel is the first person in Nevada to be charged for illegal distribution of opioid drugs since the U.S. Department of ... Read More