Stonecold Investigations

Transcription

1 Stonecold Investigations Composed of two pharmacists with 35 years of combined experience as pharmaceutical inspectors for the Florida Department of Health and two retired Miami Dade detectives with over 50 years of police experience. All were involved in reshaping the Florida Drug Device and Cosmetic Act. Requiring drug pedigree and increasing criminal penalties.

2 Accomplishments Since Going Private Contracted with 12 major pharmaceutical manufacturers to assist local, state and federal agencies with the investigation of 6 highly organized criminal cells trafficking in pharmaceutical diversion & counterfeiting. The investigation has resulted in over 85 arrests since For the last 2 years have been contracted with a major health insurance company. During this period our work has resulted in the savings of $30 million in false billings by 120 clinics in Miami Dade County for HIV infusion and in the termination of 40 pharmacies from their provider list. These 40 pharmacies were paid about $7 million the previous year.

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4 Huge and out of control problem. Drugs dispensed to Florida Medicaid and Medicare patients being resold in huge quantities into a black market and reentering the wholesale drug supply. Thereby polluting the entire nation s drug supply.

5 Diverted Drug Sources the Florida Experience Stolen in burglaries and cargo highjackings about 10% Counterfeited less than 1% (FDA estimate) Medicaid and / or Medicare fraud over 85%

6 Especially HIV and Anti-Psychotic Drugs The HHS OIG issued a report in November 2007 stating that the Tri-County area composed of Palm Beach, Broward and Miami-Dade has 8% of the nation s HIV population. Yet they account for 74% of the HIV billings to Medicare. Cases have been made in S. Fl where patients have been falsely diagnosed as HIV +. This is accomplished by the purchase of blood from HIV + patients by laboratory owners who are part of the scheme. No study has been made yet on the anti-psychotics, but the problem is probably just as great. In Miami Dade payment of $200 to shady psychiatrists will get you diagnosed as mentally disabled. Both of these diagnosis allows professional beneficiaries to extract lots of $ from the system.

7 Professional patients gathering at dawn to get their antipsychotic Rxs at a prolific prescriber s clinic. They proceed to get the drugs dispensed paid for by Medicaid or Medicare and then sell them. A weekly event on Saturdays.

8 PHARMACY BILLS MEDICAID PHARMACY DELIVERS THE IVIG MEDICATION TO CLINIC FOR INFUSION & PAYS A KICK- BACK TO CLINIC DOCTOR AT CLINIC WRITES PRESCRIPTION FOR 35 TO 40 GRAMS OF IVIG MEDICATION PATIENTS ARE INFUSED WITH 5 GRAMS OF IVIG MEDICINE OR ONLY GIVEN VITAMIN INFUSIONS REMAINING 30 TO 35 GRAMS SOLD TO UNLICENSED WHOLESALERS IVIG RE- INTRODUCED BACK INTO THE MARKET Medicare/Medicaid

9 Medicaid Drugs found inside abandoned apartment in Miami used as a crack house.

10 NEUPOGEN / EPOGEN Dispensed Neupogen and Epogen, among other drugs, found in the trunk of a Miami street drug dealer. Both Neupogen and Epogen require refrigeration. All drugs had been dispensed to Medicaid patients..

11 Who are the Victims of Bad Drugs? HIV+ PATIENTS TAXPAYERS CANCER PATIENTS ELDERLY PRIVATE INSURANCE COMPANIES HEALTH IMPACT Sub-potent, ineffective medication; Medical complications; Adverse effects of alternate treatments; Death FINANCIAL IMPACT Millions of $$ in adulterated, sub- potent drug therapies, Increased healthcare costs.

12 Why is Medicare fraud rampant in South Florida? System was created based on the honor system. Pays 1 st and investigates later. Too easy to obtain a provider number. Culture of fraud. Beneficiaries are sacred. They are an essential component of the fraud schemes, but prosecutions are very rare. In S. Florida the Medicaid Fraud Unit is forbidden to investigate them. Threshold for prosecution too high. Not enough law enforcement. Between HHS-OIG & FBI there are about 50 investigators and the U.S. Attorney s Office has 11 prosecutors. There are 400 independent pharmacies, 1500 DMEs and 738 medical clinics in Miami Dade County alone. Only one dedicated FDLE Agent to investigate Rx Drug crimes.

13 What can be done to stem the fraud? Drastic circumstances require drastic solutions. Require new provider applicants to be U.S. Citizens. Require a medical or health license to own a provider. Prosecute the professional beneficiaries and take away their benefits or place them in an HMO with restricted drug formularies. Retest at a Federal government lab all newly diagnosed HIV + and mentally disabled patients in S. Florida. Pilot project (Miami Dade County). With regards to pharmacy, mandate that all Rx drugs be dispensed by pharmacies in other than the original manufacturers containers. Concentrate the number of law enforcement personnel from around the country in S. Florida for 6 months to 1 year. So that the ratio to providers is similar to the rest of the country. Lower the monetary threshold for prosecution and take away all assets or proceeds from fraudulent activity.

14 STONECOLD INVESTIGATIONS PHARMACEUTICAL INVESTIGATION SPECIALISTS MIAMI, FL Eugene Odin, PhD, RPh Cesar Arias, RPh John Petri, MDPD, Ret Randy Jones, MDPD, Ret