Monitoring Controlled Substance Prescriptions in Your Practice

In light of increased federal surveillance, physicians must examine their controlled substance prescribing protocols.

Earlier this month in the Southern District of New York, government attorneys and enforcement officials announced the unsealing of an indictment of 24 defendants connected with "Astramed," a franchise of "medical clinics" in the Bronx, which distributed more than 5 million tablets of prescription painkillers over a 3-year period.

The defendants included physicians, clinic employees, and drug dealers who "oversaw" crews of "patients" who they sent into the clinics in order to obtain medically unnecessary prescriptions. The prescriptions were then filled at pharmacies, and the resulting pills resold on the streets of New York and elsewhere. Over 31,000 prescriptions equated to a street value of over $170 million dollars and Dr. Robert Terdiman was portrayed by the special narcotics prosecutor as "selling prescriptions for highly addictive painkillers on a scale we have not seen before - flooding the black market with oxycodone carrying a street value of over $90 million."

For physicians this incident is cause to examine prescribing habits. The Healthcare Fraud Prevention and Enforcement Task Force (HEAT), which is a joint initiative between the U.S. Department of Health and Human Services and the U.S. Department of Justice, is not overlooking this matter. "Hot zones" of enforcement (i.e., Zone 4 and Zone 7), which include Miami and Houston, have already seen similar enforcement actions for both durable medical equipment and prescribing habits.

Moreover, as more focus is placed upon state monitoring programs and the wide-spread abuse of addictive prescription drugs, physicians may be looked at more closely by the HEAT task force, the Drug Enforcement Agency and related state agencies. In sum, physicians play a crucial role in self-monitoring and the welfare of their patients. Assessing policies and prescribing habits in relation to applicable state and federal laws and regulations may help both the physician and the patients they serve.