COMBATING PHARMACEUTICAL DIVERSION: TARGETING ROGUE PAIN CLINICS & PILL MILLS
|
|
|
- Ezra Arnold
- 10 years ago
- Views:
Transcription
1 COMBATING PHARMACEUTICAL DIVERSION: TARGETING ROGUE PAIN CLINICS & PILL MILLS May 4 & 5, 2013 Prescription Drug Awareness Conference (PDAC) Detroit, Michigan Alan G. Santos, Associate Deputy Assistant Administrator, Operations Division, Office of Diversion Control, U.S. Drug Enforcement Administration
2 Outline What Rogue Pain Clinics & Pill Mills Look Like (& How They Operate) What Authorities are Doing to Target the Problem Expansion of the Problem. FLORIDA! Pill Mills on the Move EVERYWHERE! What Pharmacists Can Do to Help! U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
3 WHAT ROGUE PAIN CLINICS & PILL MILLS LOOK LIKE (& HOW THEY OPERATE) U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
4 Bad Doctors, Pill Mills, & Rogue Pain Clinics Have Been Around a Long Time! GENESIS OF THE PROBLEM U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
5 U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
6 U.S. Drug Enforcement Administration / Operations
7 U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
8 You Need to Find your Clinic 8
9 You Need to Get a Ride 9
10 But be careful Who You Ride with 10
11 A Long Line.. 11
12 Make Sure You Follow the Instructions 12
13 13 All the Instructions
14 And More Instructions!!!! 14 Pharmaceutical Investigations (ODP)
15 Get Searched and Give Up Your Weapons!!! 15
16 Give Up Your Weapons!!!!!! Clinic Owner s Weapons 16
17 All of your Weapons!!!!! 17
18 Take a Seat in the Waiting Room (if you can find one) Its Going to be a While!!! 18 Pharmaceutical Investigations (ODP)
19 I mean a long wait!!
20 Get your Script (s)!! 20
21 Pay for your Scripts!!!! 21
22 Pack for Transport Home (Which is often out of State)! 22
23 and take part of your payment Oxy Smoke 23 Pharmaceutical Investigations (ODP)
24 WHAT AUTHORITIES ARE DOING TO TARGET THE PROBLEM U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
25 Realignment of DEA s Diversion Control Efforts In October 2008, the then Acting Administrator authorized a two-pronged reorganization of the DEA Diversion Control Program. The first prong involved a substantial expansion in the number of Tactical Diversion Squads (TDS) and their deployment throughout the United States. This approach provides a significant increase in the number of Special Agents and Task Force Officers who possess the requisite law enforcement authorities needed when conducting criminal investigations, i.e., the ability to conduct surveillance, make arrests and execute search warrants. U.S. Drug Enforcement Administration Operations Division / Office of Diversion Control
26 First Prong: Increased Enforcement Efforts Currently 48 operational Tactical Diversion Squads (TDS) throughout the United States. Phase II implementation has begun with additional TDS groups being deployed across the U.S. (10 more recently approved) These TDS enforcement groups incorporate the skill sets of DEA Special Agents, Diversion Investigators, other federal law enforcement, and state and local Task Force Officers.
27 Second Prong: Renewed Focus on Regulatory Oversight The second prong of the reorganization plan called for a renewed focus on DEA s regulatory oversight of more than 1.4 million DEA registrants. With more Diversion Investigators available to concentrate on the regulatory aspects of the Diversion Control Program, the lifeblood of the program, DEA increased the frequency of compliance inspections of specific registrant categories such as manufacturers (including bulk manufacturers); distributors; importers; exporters; narcotic treatment programs; DATA-waived practitioners; researchers; and chemical handlers. This renewed focus on oversight has enabled DEA to take a more proactive approach to educate registrants and ensure that DEA registrants understand and comply with the Controlled Substances Act and implementing regulations. U.S. Drug Enforcement Administration Operations Division / Office of Diversion Control
28 EXPANSION OF THE PROBLEM FLORIDA! U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
29 The Pill Mill Epidemic WELCOME TO FLORIDA 29
30 Source: Bloomberg Businessweek, June 11-June 17, 2012
31 American Pain: The Largest U.S. Pill Mill s Rise and Fall From 2008 to 2010, according to federal agents, the George twins were the largest illegal dispensers of oxycodone in the U.S. Jeffrey George, now serving 15 ½ years Christopher George, now serving 17 ½ years Source: Bloomberg Businessweek, June 11-June 17, 2012
32 Doctors in Demand to Fill Scripts Florida Pain Clinics Craig s List Ads 32
33 Explosion of South Florida Pain Clinics All Providers (Current and Closed) All/State of Florida: 1,501 Broward County: 236 Miami-Dade County: 156 Palm Beach County: 161 Hillsborough County (Tampa area): 214 As of February 12, 2013.
34 Identifying the Pill Mills Sources of complaints: Pharmacies Medical Boards Citizen Complaints Police Intelligence Package Deliveries Intercepted parcels Medical Examiner s Office - Overdoses Court System; Probation Officers Crime Stopper Alerts Informants 34
35 Identifying & Targeting the Florida Pill Mills Increase in activity and numbers of clinics opened Surrounding business and residential Complainants Increase in amount of police contacts and arrests locally Increase in calls from North Florida and out-of-state law enforcement 35
36 Operation Pill Nation Miami Field Division Operation began on February 14, 2010 DEA, working with other federal, state and local partners, started identifying, targeting and investigating rogue pain clinics Eleven (11) Tactical Diversion Squads (TDS) from across the United States provided assistance; 340 Undercover Buys from more than 48 clinics and 64 doctors Three purchases were made from every target clinic/pharmacy prescribed with no legitimate medical purpose 36
37 Operation Pill Nation On February 23, 2011, as part of Operation Pill Nation DEA conducted a coordinated effort with more than 500 state and local law enforcement officers in a massive takedown which included: 21 search warrants executed at clinics, residences, and other locations in south Florida; 25 arrested on various federal and state drug and money laundering charges, of which 5 were medical doctors and 5 were pain clinic owners; Seizure of approximately $9.5 million in assets. ($3 million dollars in US currency, a variety of other real property, jewelry, and assets including 68 vehicles, some of which were exotic cars); and Immediate Suspension Orders issued against 14 DEA registrations, 1 Order to Show Cause issued against 3 DEA registrations, and the surrender of 6 DEA registrations.
38 Operation Pill Nation To date, Operation Pill Nation (Parts I & II) have resulted in: The surrender of 92 DEA registrations (80 physicians, 8 pharmacies and 4 wholesale distributors); 1 wholesale distributor s civil fine was $8 million Immediate Suspension Orders issued against 63 DEA registrations (62 physicians, 1 distributor); Orders to Show Cause issued against 6 DEA registrations; 40 clinics closed; 47 arrests (27 physicians, 5 clinic owners and 15 clinic employees) Seizure of more than $18.9 million in assets ($12.1 million in US currency and approximately $6.8 million in vehicles, jewelry, real property, and other assets).
39 Enforcement Results* : CIVIL ACTIONS: Operation Pill Nation Miami Field Division Assets Seized : $19,022, (US Currency, Vehicles, Jewelry, Real Estate and Weapons) * Totals as of October 1,
40 Seized Assets Operation Pill Nation Miami Field Division
41 41
42 Increase/Decrease in Purchases of Oxycodone by Florida Physicians National ranking of top 100 oxycodone purchasing physicians Prior to Operation Pill Nation: 90 of top 100 in State of Florida After Operation Pill Nation: 13 of top 100 in State of Florida 42
43 Increase/Decrease in Purchases of Oxycodone by Florida Pharmacies January-September 2011 Jan 1.51% Feb 2.72% Mar 2.83% Apr % May % Jun % Jul % Aug % Sep % Source: DEA ARCOS 43
44 June 2010 DEA takes action against four wholesale distributors supplying doctors who were dispensing from rogue pain clinics.
45 State of Florida Legislative Actions Effective October 1, 2010 Pain clinics are banned from advertising that they sell narcotics They can only dispense 72-hour supply of narcotics Prohibits the registration of pain clinics unless they are owned by physicians or licensed by non-physicians as a health care clinic Effective July 1, 2011 Clinics must turn over their supply of C-II and C-III controlled substances Clinics are no longer able to dispense these drugs Clinics cannot have ANY affiliation with a doctor that has lost a DEA number
46 PILL MILLS ON THE MOVE. EVERYWHERE! U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
47 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
48 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
49 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
50 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
51 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
52 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
53 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
54 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
55 MIGRATION OF PAIN CLINICS N.H. WASHINGTON MONTANA MINNOSOTA VT. MAINE OREGON NEVADA IDAHO UTAH WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS IOWA WISC. ILL. MICH. IND. OHIO N.Y. PENN. W.V. VIRGINIA MASS. R.I. CONN. N.J. DEL. MD. CALFORNIA ARIZONA NEW MEXICO TEXAS OKLAHOMA MISSOURI ARKANSAS KENTUCKY TENN. ALA. MISS. N.C. S.C. LOUIS. GEORGIA FLA.
56 Georgia Example: Traditional Pain Management Clinics Years prior to : legitimate clinics Almost all owned by Physicians Accept insurance, Medicaid, Medicare, etc. Patients need appointments Follow pain management guidelines Patients get a complete physical workup & exam Use physical therapy, other treatment methods Prescribed drugs usually include non-narcotics
57 Georgia Pain Pill Clinics Now in 2012 approximately 125 rogue clinics owned by non-physicians, and the owners: Are from another state Many are convicted felons Usually owned or operated a pain clinic in another state. Have ties to some type of organized crime If from Florida, left not because of the Florida PMP, but due to new Pain Clinic restrictions and no dispensing
58 Georgia-Based Pharmaceutical DTO Dismantled Dr. William Garrett, arrested on November 15. Agents and diversion investigators from the DEA Atlanta and Houston Division Offices and the London, Kentucky Resident Office, along with various state and local officers, arrested Dr. William Garrett and pain clinic owners William Benton, Curtis Wills, and Richard Romero, and six pharmacists on November 15. The arrests resulted in the dismantlement of the Benton and Malcolm Garrett pharmaceutical trafficking organization. An Immediate Suspension Order was served on William Garrett, a licensed physician in Georgia. Benton, Malcolm Garrett, and Wills owned and operated pain clinics in DeKalb and Fulton County, Georgia. Romero was formerly an owner of the pain clinic in DeKalb County and also was involved in money laundering. Since October 2010, William Garrett worked as a physician at both pain clinics where he fraudulently prescribed controlled substances, particularly oxycodone and alprazolam, to individuals without establishing a proper doctor/patient relationship and outside the scope of professional practice. These individuals were then directed to target pharmacies throughout Georgia where pharmacists filled controlled substance prescriptions knowing the prescriptions were written without a legitimate medical purpose. The pain clinic in Fulton County had approximately 1,600 patients, of which 98 percent traveled from other states including Kentucky, Ohio, Tennessee, West Virginia, and Wisconsin. To date, this 12-month SOD-supported investigation, dubbed OperationOxy Alley, has resulted in the arrest of 11 individuals, including Malcolm Garrett, and the seizure of $1.3 million in U.S. currency and personal property valued at $400,000 dollars.
59 California Example: Doctor Sells More then Pharmacies The Duarte physician ordered more Vicodin than any doctor in the nation 1 million pills in That s 10 times the stockpile of an average pharmacy; more than his local CVS, Wal- Mart, Target, and City of Hope pharmacies combined.
60 WHAT PHARMACISTS CAN DO TO HELP! U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
61 System of Checks and Balances The Last Line of Defense
62 Checks and Balances Under the CSA Pharmacists The Last Line of Defense The responsibility for the proper prescribing and dispensing of controlled substances is upon the practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. (21 CFR (a))
63 The Corresponding Responsibility Rests with the Pharmacist who fills the Prescription Patient Practitioner Training & Experience States Prescription Monitoring Program DEA Web-Site / DEA Number Verification World-Wide-Web Resources
64 Why Wouldn t You Use All the Tools Available? States Prescription Monitoring Program CHAIN RX - PHARMACY DEA Web-Site / DEA Number Verification World-Wide-Web Resources Patient Practitioner Training & Experience
65 Potential Red Flags Many customers receiving the same combination of prescriptions Many customers receiving the same strength of controlled substances; Many customers paying cash for their prescriptions; Many customers with the same diagnosis codes written on their prescriptions; Individuals driving long distances to visit physicians and/or to fill prescriptions; Customers coming into the pharmacy in groups, each with the same prescriptions issued by the same physician; and Customers with prescriptions for controlled substances written by physicians not associated with pain management (i.e., pediatricians, gynecologists, ophthalmologists, etc.).
66 Status of State Prescription Drug Monitoring Programs (PDMPs) As of 01/02/2013. * The operation of Nebraska s PDMP is currently being facilitated through the state s Health Information Initiative. Participation by patients, physicians, and other health care providers is voluntary.
67
68
69
70
71 Thank You / Questions U.S. Drug Enforcement Administration / Operations Division / Office of Diversion Control
Impacts of Sequestration on the States
Impacts of Sequestration on the States Alabama Alabama will lose about $230,000 in Justice Assistance Grants that support law STOP Violence Against Women Program: Alabama could lose up to $102,000 in funds
Table of Mortgage Broker (and Originator) Bond Laws by State Current as of July 1, 2010
Alabama Ala. Code 5-25-5 Bond only required where licensee does not submit evidence of net worth. Loan originators may be covered by Alaska 25,000 Alaska Stat. 06.60.045 Arizona $10,000-$15,000 Ariz. Rev.
Predict. Prevent. Protect. Transform.
Optum solution uses global positioning system technology for Optum (CES) is an open-architecture claims editing tool that Program Integrity Solutions Optum provides 30 years worth of government expertise
Table A-7. State Medical Record Laws: Minimum Medical Record Retention Periods for Records Held by Medical Doctors and Hospitals*
Summary of statutory or regulatory provision by entity. Alabama As long as may be necessary to treat the patient and for medical legal purposes. Ala. Admin. Code r. 545-X-4-.08 (2007). (1) 5 years. Ala.
CAPITOL research. Interstate Information Sharing: Prescription Drug Monitoring Programs
The Council of State governments CAPITOL research APRIL 00 Prescription Drug Monitoring Interstate Information Sharing: Prescription Drug Monitoring Programs The Council of State Governments Misuse of
This chart accompanies Protection From Creditors for Retirement Plan Assets, in the January 2014 issue of The Tax Adviser.
This chart accompanies Protection From Creditors for Retirement Plan Assets, in the January 2014 issue of The Tax Adviser. State-by-state analysis of IRAs as exempt property State State Statute IRA Alabama
Three-Year Moving Averages by States % Home Internet Access
Three-Year Moving Averages by States % Home Internet Access Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana
STATE BY STATE ANTI-INDEMNITY STATUTES. Sole or Partial Negligence. Alaska X Alaska Stat. 45.45.900. Except for hazardous substances.
State STATE BY STATE ANTI-INDEMNITY STATUTES Sole Negligence Sole or Partial Negligence Closes A.I. Loophole Comments Alabama Alaska Alaska Stat. 45.45.900. Except for hazardous substances. Arizona (Private
Public School Teacher Experience Distribution. Public School Teacher Experience Distribution
Public School Teacher Experience Distribution Lower Quartile Median Upper Quartile Mode Alabama Percent of Teachers FY Public School Teacher Experience Distribution Lower Quartile Median Upper Quartile
2015 ANNUAL REVIEW OF PRESCRIPTION MONITORING PROGRAMS
2015 ANNUAL REVIEW OF PRESCRIPTION MONITORING PROGRAMS Research current through September 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy.
Chart Overview of Nurse Practitioner Scopes of Practice in the United States
Chart Overview of Nurse Practitioner Scopes of Practice in the United States Sharon Christian, JD, Catherine Dower, JD, Edward O Neil, PhD, MPA, FAAN Center for the Health Professions University of California,
False Claims Act Regulations by State
False Claims Act Regulations by State Under the False Claims Act, 31 U.S.C. 3729-3733, those who knowingly submit, or cause another person or entity to submit, false claims for payment of The purpose of
Mandatory Reporting of Child Abuse 6/2009 State Mandatory Reporters Language on Privilege Notes Alabama
Alabama any other person called upon to render aid to any child ALA. CODE 26-14-10 Alaska ALA. CODE 26-14-3(a) paid employees of domestic violence and sexual assault programs, and crisis intervention and
PA CME Requirements. Alaska Alaska Physician Assistants must maintain an active NCCPA certification for license renewal.
PA CME Requirements Alabama Alabama Physician Assistants must complete 25 hours of AMA PRA Category 1 or equivalent (AOA, AAFP, ACOG) CME every year for annual license renewal. If the licensee does not
NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST
NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST ** Utilize this list to determine whether or not a non-resident applicant may waive the Oklahoma examination or become licensed
Video Voyeurism Laws
Video Voyeurism Laws Federal Law Video Voyeurism Prevention Act of 2004, 18 U.S.C.A. 1801. Jurisdiction limited to maritime and territorial jurisdiction, or federal property including but not limited to
DRUGS, DRUGS, & MORE DRUGS. William T. Winsley, M.S., R.Ph. Former Exec. Dir., Ohio Board of Pharmacy Past President, NABP bill.winsley@icloud.
DRUGS, DRUGS, & MORE DRUGS William T. Winsley, M.S., R.Ph. Former Exec. Dir., Ohio Board of Pharmacy Past President, NABP [email protected] Duties of the Ohio Board of Pharmacy Licensing/Administrative
MAINE (Augusta) Maryland (Annapolis) MICHIGAN (Lansing) MINNESOTA (St. Paul) MISSISSIPPI (Jackson) MISSOURI (Jefferson City) MONTANA (Helena)
HAWAII () IDAHO () Illinois () MAINE () Maryland () MASSACHUSETTS () NEBRASKA () NEVADA (Carson ) NEW HAMPSHIRE () OHIO () OKLAHOMA ( ) OREGON () TEXAS () UTAH ( ) VERMONT () ALABAMA () COLORADO () INDIANA
Prescription Monitoring Programs: Creating a National Network
Prescription Monitoring Programs: Creating a National Network Danna E. Droz, JD, RPH PMP Liaison [email protected] 847/391-4508 United States Drug Enforcement Administration National Conference on Pharmaceutical
Penalties by State for Driving While Revoked, Suspended or Otherwise Unlicensed
Penalties by State for Driving While Revoked, Suspended or Otherwise Unlicensed State Citation Penalties Alabama 32-6-19 Misdemeanor.100-$500 fine, additional fine of $50; Possible jail sentence of not
The National Progress Report on e-prescribing and Safe-Rx Rankings
The National Progress Report on e-prescribing and Safe-Rx Rankings YEAR 2012 neutrality transparency physician and patient choice open standards collaboration privacy THE national progress report ON E-prescribing
Englishinusa.com Positions in MSN under different search terms.
Englishinusa.com Positions in MSN under different search terms. Search Term Position 1 Accent Reduction Programs in USA 1 2 American English for Business Students 1 3 American English for Graduate Students
ADULT PROTECTIVE SERVICES, INSTITUTIONAL ABUSE AND LONG TERM CARE OMBUDSMAN PROGRAM LAWS: CITATIONS, BY STATE
ADULT PROTECTIVE SERVICES, INSTITUTIONAL ABUSE AND LONG TERM CARE OMBUDSMAN PROGRAM LAWS: CITATIONS, BY STATE (Laws current as of 12/31/06) Prepared by Lori Stiegel and Ellen Klem of the American Bar Association
MEDICAL MALPRACTICE STATE STATUTORY
MEDICAL MALPRACTICE STATE STATUTORY REFERENCE GUIDE 41 MEDICAL MALPRACTICE STATE STATUTORY REFERENCE GUIDE The following references to statutes relevant to medical malpractice cases are intended exclusively
Licensure Resources by State
Licensure Resources by State Alabama Alabama State Board of Social Work Examiners http://socialwork.alabama.gov/ Alaska Alaska Board of Social Work Examiners http://commerce.state.ak.us/dnn/cbpl/professionallicensing/socialworkexaminers.as
State Income and Franchise Tax Laws that Conform to the REIT Modernization Act of 1999 (May 1, 2001). 1
State Income and Franchise Tax Laws that Conform to the REIT Modernization Act of 1999 (May 1, 2001). 1 1. Alabama does not adopt the Code on a regular basis but instead specifically incorporates only
Model Regulation Service October 1993
Table of Contents Section 1. Section 2. Section 3. Section 4. Section 5. Section 6. Section 7. Section 1. Model Regulation Service October 1993 PERMITTING SMOKER/NONSMOKER MORTALITY TABLES Authority Purpose
PRODUCER MILK MARKETED UNDER FEDERAL MILK ORDERS BY STATE OF ORIGIN, 2005
PRODUCER MILK MARKETED UNDER FEDERAL MILK ORDERS BY STATE OF ORIGIN, 2005 During 2005, milk processors regulated under the Federal milk order (FMO) system purchased about 115 billion pounds of milk from
PUBLIC INSURANCE ADJUSTER FEE PROVISIONS 50 STATE SURVEY AS OF 6/29/07. LIKELY YES [Cal. Ins. Code 15027]
![PUBLIC INSURANCE ADJUSTER FEE PROVISIONS 50 STATE SURVEY AS OF 6/29/07. LIKELY YES [Cal. Ins. Code 15027]](/thumbs/39/20128928.jpg "PUBLIC INSURANCE ADJUSTER FEE PROVISIONS 50 STATE SURVEY AS OF 6/29/07. LIKELY YES [Cal. Ins. Code 15027]")
Alabama Alaska Arizona Arkansas California [Cal. Ins. Code 15027] ] Colorado [Cal. Ins. Code 15027] Connecticut Delaware of the actual or final settlement of a loss [Conn. Ins. Code 38a-788-8] 2.5% of
High Risk Health Pools and Plans by State
High Risk Health Pools and Plans by State State Program Contact Alabama Alabama Health 1-866-833-3375 Insurance Plan 1-334-263-8311 http://www.alseib.org/healthinsurance/ahip/ Alaska Alaska Comprehensive
Juvenile Life Without Parole (JLWOP) February 2010
Life Without Parole (JLWOP) February 2010 STATE LWOP Law JLWOP 1 ALABAMA YES 62 0 court Ala. Stat. 13A-6-2 ALASKA No LWOP parole always possible No -- -- - Max. age of 18 yrs. old Alaska Stat. 11.41.100
BUSINESS DEVELOPMENT OUTCOMES
BUSINESS DEVELOPMENT OUTCOMES Small Business Ownership Description Total number of employer firms and self-employment in the state per 100 people in the labor force, 2003. Explanation Business ownership
Economic Impact and Variation in Costs to Provide Community Pharmacy Services
Economic Impact and Variation in Costs to Provide Community Pharmacy Services Todd Brown MHP, R.Ph. Associate Clinical Specialist and Vice Chair Department of Pharmacy Practice School of Pharmacy Northeastern
Workers Compensation State Guidelines & Availability
ALABAMA Alabama State Specific Release Form Control\Release Forms_pdf\Alabama 1-2 Weeks ALASKA ARIZONA Arizona State Specific Release Form Control\Release Forms_pdf\Arizona 7-8 Weeks by mail By Mail ARKANSAS
State-Specific Annuity Suitability Requirements
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Effective 10/16/11: Producers holding a life line of authority on or before 10/16/11 who sell or wish to sell
County - $0.55/$500 - $.75/$500 depending on +/- 2 million population 0.11% - 0.15% Minnesota
22-Apr-13 State Deed Transfer and Mortgage Tax Rates, 2012 Alabama State Tax Description Transfer Fee Rate Deeds $0.50/$500 0.10% Mortgages $0.15/$100 0.15% Alaska Arizona $2 fee per deed or contract Flat
Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth
Prescription drug abuse trends Minnesota s Prescription Monitoring Program Carol Falkowski Drug Abuse Dialogues www.drugabusedialogues.com Barbara Carter, Manager MN Board of Pharmacy www.pmp.pharmacy.state.mn.us
Hail-related claims under comprehensive coverage
Bulletin Vol. 29, No. 3 : April 2012 Hail-related claims under comprehensive coverage Claims for hail damage more than doubled in 2011 compared with the previous three years. Hail claims are primarily
SURVEY OF THE CURRENT INSURANCE REGULATORY ENVIRONMENT FOR AFFINITY MARKETIG 1 A
SURVEY OF THE CURRENT INSURANCE REGULATORY ENVIRONMENT FOR AFFINITY MARKETIG ARRANGEMENTS (FORC Journal: Vol. 23 Edition 4 - Winter 2012) Kevin G. Fitzgerald, Esq. (414) 297-5841 N. Wesley Strickland (850)
Chex Systems, Inc. does not currently charge a fee to place, lift or remove a freeze; however, we reserve the right to apply the following fees:
Chex Systems, Inc. does not currently charge a fee to place, lift or remove a freeze; however, we reserve the right to apply the following fees: Security Freeze Table AA, AP and AE Military addresses*
Net-Temps Job Distribution Network
Net-Temps Job Distribution Network The Net-Temps Job Distribution Network is a group of 25,000 employment-related websites with a local, regional, national, industry and niche focus. Net-Temps customers'
DEA Washington Division Diversion Control Program
SOUTHWEST VIRGINIA PRESCRIPTION DRUG ABUSE SUMMIT DEA Washington Division Diversion Control Program Mary Johnson-Rochee Diversion Program Manager November 14, 2012 Topics: DEA s Diversion Mission How DEA
50-State Analysis. School Attendance Age Limits. 700 Broadway, Suite 810 Denver, CO 80203-3442 303.299.3600 Fax: 303.296.8332
0-State Analysis School Attendance Age Limits 700 Broadway, Suite 810 Denver, CO 80203-32 303.299.3600 Fax: 303.296.8332 Introduction School Attendance Age Limits By Marga Mikulecky April 2013 This 0-State
NAIC ANNUITY TRAINING Regulations By State
Select a state below to display the current regulation and requirements, or continue to scroll down. Light grey text signifies states that have not adopted an annuity training program. Alabama Illinois
Default Definitions of Person in State Statutes
Default Definitions of Person in State Statutes State Alabama ALA. CODE 1-1-1 (2014) 1-1-1. Definitions. The following words, whenever they appear in this code, shall have the signification attached to
American C.E. Requirements
American C.E. Requirements Alaska Board of Nursing Two of the following: 30 contact hours 30 hours of professional nursing activities 320 hours of nursing employment Arizona State Board of Nursing Arkansas
Liquor Wine Beer Other taxes
6-Feb-5 State Alcohol Excise Tax Rates 205 State Tax Rate ($ per gallon) Sales tax applied? Liquor Wine Beer Tax Rate Sales tax Tax Rate Sales tax ($ per gallon) applied? ($ per gallon) applied? Alabama
In-state Tuition & Fees at Flagship Universities by State 2014-15 Rank School State In-state Tuition & Fees Penn State University Park Pennsylvania 1
In-state Tuition & Fees at Flagship Universities by State 2014-15 Rank School State In-state Tuition & Fees Penn State University Park Pennsylvania 1 $18,464 New New Hampshire 2 Hampshire $16,552 3 Vermont
Model Regulation Service - January 1993 GUIDELINES ON GIFTS OF LIFE INSURANCE TO CHARITABLE INSTITUTIONS
Model Regulation Service - January 1993 These Guidelines have been prepared for use by state insurance department personnel who may be presented with questions or concerns regarding charitable gifts of
SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS. The Board of Governors of the Federal Reserve System (Board), the Federal Deposit
SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS The Board of Governors of the Federal Reserve System (Board), the Federal Deposit Insurance Corporation (FDIC), and the Office of the Comptroller of the Currency
State Pest Control/Pesticide Application Laws & Regulations. As Compiled by NPMA, as of December 2011
State Pest Control/Pesticide Application Laws & As Compiled by NPMA, as of December 2011 Alabama http://alabamaadministrativecode.state.al.us/docs/agr/mcword10agr9.pdf Alabama Pest Control Alaska http://dec.alaska.gov/commish/regulations/pdfs/18%20aac%2090.pdf
State by State Summary of Nurses Allowed to Perform Conservative Sharp Debridement
State by State Summary of Nurses Allowed to Perform Conservative Sharp Debridement THE FOLLOWING ARE ONLY GENERAL SUMMARIES OF THE PRACTICE ACTS EACH STATE HAS REGARDING CONSERVATIVE SHARP DEBRIDEMENT
SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS. or branches outside of its home state primarily for the purpose of deposit production.
SECTION 109 HOST STATE LOAN-TO-DEPOSIT RATIOS The Board of Governors of the Federal Reserve System, the Federal Deposit Insurance Corporation, and the Office of the Comptroller of the Currency (the agencies)
Real Progress in Food Code Adoption
Real Progress in Food Code Adoption The Association of Food and Drug Officials (AFDO), under contract to the Food and Drug Administration, is gathering data on the progress of FDA Food Code adoptions by
State Tax Information
State Tax Information The information contained in this document is not intended or written as specific legal or tax advice and may not be relied on for purposes of avoiding any state tax penalties. Neither
Listing of Mortgage Broker Definitions
State Definition Citation Text ALABAMA MORTGAGE BROKERS LICENSING ACT Mortgage broker means any person who directly or indirectly solicits, Ala. Code 5 25 2(9) processes, places, or negotiates mortgage
LEGAL BARRIERS FOR PEOPLE IN RECOVERY FROM DRUG AND ALCOHOL ADDICTION: LICENSES AND CREDENTIALS
LEGAL BARRIERS FOR PEOPLE IN RECOVERY FROM DRUG AND ALCOHOL ADDICTION: LICENSES AND CREDENTIALS There are many legal obstacles facing people who have overcome addiction and are in good recovery. This memorandum
Real Progress in Food Code Adoption
Real Progress in Food Code Adoption August 27, 2013 The Association of Food and Drug Officials (AFDO), under contract to the Food and Drug Administration, is gathering data on the progress of FDA Food
Medico s s Medicare Supplement Policies
Medico s s Medicare Supplement Policies Today s s Topics Who is Medico? Overview of the Medico Information Center (MIC) Overview of our Medicare Supplement Product The Basics Availability Competitive Information
Alaska (AK) Arizona (AZ) Arkansas (AR) California-RN (CA-RN) Colorado (CO)
Beth Radtke 50 Included in the report: 7/22/2015 11:15:28 AM Alaska (AK) Arizona (AZ) Arkansas (AR) California-RN (CA-RN) Colorado (CO) Connecticut (CT) Delaware (DE) District Columbia (DC) Florida (FL)
APPENDIX 4. A. State Courts. Alaska Superior Court. Alabama Court of Criminal Appeals Alabama Circuit Court. Arizona Superior Court
APPENDIX 4 COURT ABBREVIATIONS This appendix contains abbreviations for federal courts. Abbreviations for state courts can be developed by consulting Appendix 1 and Rule 2 concerning abbreviations and
Doctor Shopping Laws. Introduction
Doctor Shopping Laws The United States is in the midst of an unprecedented epidemic of prescription drug overdose deaths. 1 More than 41,000 people died of drug overdoses in 2011, and most of these deaths
Prescription Drug Time and Dosage Limit Laws
Prescription Drug Time and Dosage Limit Laws The United States is in the midst of an unprecedented epidemic of prescription drug overdose deaths. 1 Nearly 44,000 people died of drug overdoses in 2013,
Property Assessment Standards in the United States
Property Assessment Standards in the United States Larry DeBoer Department of Agricultural Economics, Purdue University January, 2000 An assessment standard defines the taxable value of property that assessors
Acceptable Certificates from States other than New York
Alabama 2 2 Professional Educator Certificate 5 Years Teacher Yes Professional Educator Certificate 5 Years Support Services Yes Alaska 2 Regular Certificate, Type A 5 Years, renewable Teacher Yes At least
E-Prescribing Trends in the United States. Meghan Hufstader Gabriel, PhD & Matthew Swain, MPH
ONC Data Brief No. 18 July 2014 E-Prescribing Trends in the United States Meghan Hufstader Gabriel, PhD & Matthew Swain, MPH This brief focuses on changes in rates of physician e-prescribing, pharmacy
Physical Presence Triggers N/A
State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Authorization Requirements License from AL Department of Postsecondary Education; Certificate of Authority
Data show key role for community colleges in 4-year
Page 1 of 7 (https://www.insidehighered.com) Data show key role for community colleges in 4-year degree production Submitted by Doug Lederman on September 10, 2012-3:00am The notion that community colleges
Model Regulation Service April 2005 GUIDELINES ON CORPORATE OWNED LIFE INSURANCE
Model Regulation Service April 2005 Corporate Owned Life Insurance (COLI) is life insurance a corporate employer buys covering one or more employees. With COLI, the employer is generally the applicant,
Uniform Cost-Sharing Regulations
UniFirst.com Uniform Program Options Uniform Cost-Sharing Regulations Uniform cost-sharing through employee payroll deductions presents many benefits to both the uniform wearer and the company. The net
State General Sales Tax Rates 2015 As of January 1, 2015
4-Feb-15 General Sales Tax Rates 2015 As of January 1, 2015 Exemptions for General Sales Tax Rate (%) Food 1 Prescription Nonprescription Arizona 5.6 Exempt Exempt Taxable Arkansas 6.5 1.5 4 Exempt Taxable
HEALTH CARE INTERPRETERS: ARE THEY MANDATORY REPORTERS OF CHILD ABUSE? 1
1444 I St NW, Suite 1105 Washington, DC 20005 (202) 289-7661 Fax (202) 289-7724 I. Introduction HEALTH CARE INTERPRETERS: ARE THEY MANDATORY REPORTERS OF CHILD ABUSE? 1 As the nation continues to diversify
STATE-SPECIFIC ANNUITY SUITABILITY REQUIREMENTS
Alabama Alaska Arizona Arkansas California This jurisdiction has pending annuity training legislation/regulation Annuity Training Requirement Currently Effective Initial 8-Hour Annuity Training Requirement:
Rates are valid through March 31, 2014.
The data in this chart was compiled from the physician fee schedule information posted on the CMS website as of January 2014. CPT codes and descriptions are copyright 2012 American Medical Association.
State Specific Annuity Suitability Requirements updated 10/10/11
Alabama Alaska Ai Arizona Arkansas California This jurisdiction has pending annuity training legislation/regulation Initial 8 Hour Annuity Training Requirement: Prior to selling annuities in California,
Prescription Drug Abuse and Pain Management Clinics 2015 Report to the 109 th Tennessee General Assembly
Prescription Drug Abuse and Pain Management Clinics 2015 Report to the 109 th Tennessee General Assembly Andrea Huddleston, Chief Deputy General Counsel Tennessee Department of Health Office of General
Internet Prescribing Summary
Internet Prescribing Summary, Minnesota,,, South Dakota and Wisconsin (July 2011) Advancements in medicine and technology have transformed the way health care is delivered to patients. However, laws governing
States Ranked by Alcohol Tax Rates: Beer (as of March 2009) Ranking State Beer Tax (per gallon)
States Ranked by Alcohol Tax Rates: Beer (as of March 2009) Ranking State Beer Tax (per gallon) Sales Tax Applied 1 Wyoming $0.02 4% 2 4 8 10 Missouri $0.06 4.225% Wisconsin $0.06 5% Colorado $0.08 2.9%
Healthcare. State Report. Anthony P. Carnevale Nicole Smith Artem Gulish Bennett H. Beach. June 2012
Healthcare State Report June 2012 Anthony P. Carnevale Nicole Smith Artem Gulish Bennett H. Beach B Table of Contents Healthcare: State Level Analysis... 3 Alabama... 12 Alaska... 14 Arizona... 16 Arkansas...
Schedule B DS1 & DS3 Service
Schedule B DS1 & DS3 Service SCHEDULE B Private Line Data Services DS1 & DS3 Service... 2 DS-1 Local Access Channel... 2 DS-1 Local Access Channel, New Jersey... 2 DS-1 Local Access Channel, Out-of-State...
The Obama Administration and Community Health Centers
The Obama Administration and Community Health Centers Community health centers are a critical source of health care for millions of Americans particularly those in underserved communities. Thanks primarily
State Advocacy Guide to Prescription Drug Monitoring Program Legislation and Regulations
State Advocacy Guide to Prescription Drug Monitoring Program Legislation and Regulations There is currently an epidemic of prescription opioid abuse, misuse and diversion in the U.S. Numerous federal,
State Tax Information
State Tax Information The information contained in this document is not intended or written as specific legal or tax advice and may not be relied on for purposes of avoiding any state tax penalties. Neither
LPSC Renewable Energy Pilot y RFPs issued by Utility Companies by Order of Commission, November 2010
Renewable Energy LPSC Renewable Energy Pilot y RFPs issued by Utility Companies by Order of Commission, November 2010 y Searching for various forms of renewable energy and their actual cost in Louisiana
california Health Care Almanac Health Care Costs 101: California Addendum
california Health Care Almanac : California Addendum May 2012 Introduction Health spending represents a significant share of California s economy, but the amounts spent on health care rank among the lowest
TABLE OF CONTENTS 1.00 ORGANIZATION AND AUTHORITY 1.01 TAX DIVISION AUTHORITY... 1-1 1.02 CRIMINAL ENFORCEMENT SECTIONS ORGANIZATION CHART...
TABLE OF CONTENTS 1.00 ORGANIZATION AND AUTHORITY 1.01 TAX DIVISION AUTHORITY... 1-1 1.02 CRIMINAL ENFORCEMENT SECTIONS ORGANIZATION CHART... 1-3 1.03 CRIMINAL ENFORCEMENT SECTIONS -- DELEGATION OF AUTHORITY...
Postsecondary. Tuition and Fees. Tuition-Setting Authority for Public Colleges and Universities. By Kyle Zinth and Matthew Smith October 2012
Postsecondary Tuition and Fees Introduction Tuition-Setting Authority for Public Colleges and Universities By Kyle Zinth and Matthew Smith October 2012 Who sets tuition? Regardless of the state in question,
D.C. Code Ann. Prohibits employment discrimination on the basis of tobacco use except where
National Conference of State Legislatures Discrimination Laws Regarding Off-Duty Conduct Updated October 18, 2010 The issue of employees' rights to engage in certain off-duty activities and in the competing
STATE INCOME TAX WITHHOLDING INFORMATION DOCUMENT
STATE INCOME TAX WITHHOLDING INFORMATION DOCUMENT Zurich American Life Insurance Company (ZALICO) Administrative Offices: PO BOX 19097 Greenville, SC 29602-9097 800/449-0523 This document is intended to
Table 1: Advertising, Marketing and Promotional Expense as a Percentage of Net Operating Revenue
Table 1: Advertising, Marketing and Promotional Expense as a Percentage of Net Operating Revenue NAIC Group % Attorney s Title 3.8% Chicago / Fidelity 0.9% Diversified 0.6% First American 2.7% Investors
NCSL Capitol Security Survey (2009 2010)
NCSL Capitol Security Survey (2009 2010) 1. Please list your state Alabama 2 3% Alaska 1 2% Arizona 0 0% Arkansas 1 2% California 1 2% Colorado 3 5% Connecticut 0 0% Delaware 1 2% Florida 1 2% Georgia
US Department of Health and Human Services Exclusion Program. Thomas Sowinski Special Agent in Charge/ Reviewing Official
US Department of Health and Human Services Exclusion Program Thomas Sowinski Special Agent in Charge/ Reviewing Official Overview Authority to exclude individuals and entities from Federal Health Care