Had enough? Report Quality of Care issues to your state Medical Association

On February 21 I talked about the concept of Prescribing physicians who do not “get it”.  I followed that up on February 27 with some specific examples in Texas where physicians are being held accountable.  Since then, there have been several other notices of similar progress on workcompcentral (all links below require subscription):

• Florida: An article on February 28 follows the U.S. Attorney in his ongoing investigation into “Oxy Alley” of southern Florida “pill mills”.  Twenty-six defendants have been sentenced thus far, and interestingly only 13 defendants were doctors.  Two individuals, operating four “pain” clinics, distributed 20M (yes, 20,000,000) Oxycodone pills from 2008-2010 totaling $40M (yes, $40,000,000) in sales.
• California: An article on March 2 notes that Dr. Hsiu-Tyin Tseng is being held on $3M bail by the Major Narcotics Division of Los Angeles County on three counts of second-degree murder, one felony count of prescribing drugs using fraud, and 20 felony counts of prescribing drugs without a legitimate purpose.  She had formerly agreed to pay $275K to the parents of one patient who overdosed from a combination of Xanax, Roxicodone and alcohol.  She also agreed to pay $225K to the family of another patient who died from drugs prescribed by Dr. Tseng.  She was also under federal investigation for running a “pill mill”.
• Florida: An article today (March 9) talks about a “pill mill” being busted in Winter Haven FL where a NON-physician wrote scripts using the names of doctors who previously worked at the clinic and then hired hundreds of people to fill phony prescriptions (2,500 in total).  The vast majority of scripts were for the combination of Oxycodone (OxyContin) and Alprazolam (Xanax).

As I travel the country, our clients (carriers, TPA’s, self-insured employers, municipalities, excess carriers, captives, etc.) all are justifiably upset about what “bad” doctors do to their patients.  One, in North Carolina, made a very emphatic point that the problem IS the doctor.  While there are a variety of enablers throughout our society and our industry, I agree that primary culpability lies with the prescribing physicians (or, in some of the cases above, non-physicians).

If you pay a bill, you know the doctors who are over-prescribing because their name is listed.  If you see a trend over time, a prescribing physician on multiple claims with similar inappropriate regimens, compile the data and report them to your state’s Medical Association.  If it an issue of legality, report them to law enforcement.  I heard the Texas Medical Association specifically request Payers to notify them of “Quality of Care” issues.  The DEA and state/county/local officials need evidence to pursue investigations.

Hand wringing time is over.  We have the moral high ground and it's time to get these over-prescribers away from patients.

In this together – Mark

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