Tag Archives: drug diversion

PODCAST: Criminal Healthcare Fraud and Defense with Attorney Anthony Schumann

This podcast interview with Anthony Schumann focuses on current trends and topics in the area of criminal healthcare fraud and defense. In the next 30 minutes we will cover everything from how to be proactive in your practice and limit your liability, to what steps to take if you are audited, investigated or charged with a crime.


Topics covered in this 30-minute interview 

  • Introducing Anthony Schumann, tell us about your law practice
  • Sources of criminal healthcare law, state and federal
  • Enforcement areas: home health, kickbacks, mental health, drug diversion, etc.
  • What to expect during investigations and when to obtain legal defense counsel
  • Professional licensing concerns in connection with dispositions of cases
  • What to expect in defending criminal healthcare fraud charges

Anthony L. Schumann is a partner in the Chicago office of Quintairos, Prieto, Wood & Boyer, P.A.  For more than 30 years, Mr. Schumann has participated in over 150 civil and criminal trials and evidentiary hearings.  He focuses his practice in the areas of commercial litigation, employment law, government liability, and white collar criminal defense.  He has extensive experience representing corporate, governmental and individual clients in state and federal courts and during all stages of investigation and throughout the litigation process.  Mr. Schumann has extensive experience assisting companies with internal investigations and in handling compliance issues.  He has attained an AV® rating from Martindale-Hubbell Law Directory, the highest professional rating awarded for legal ability and ethical standards; and he is also included in the listings of Illinois Leading Lawyer and Illinois Super Lawyer.

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Michael V. Favia & Associates are available to advise and represent health care professionals and the general Chicagoland community with a variety of legal issues. With offices conveniently located in the Chicago Loop, Northwest side and suburbs, you can schedule a discrete meeting with an attorney at your convenience and discretion.

For more about Michael V. Favia & Associates’ professional licensing work, please call (773) 631-4580, visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You may also connect with Attorney Michael V. Favia on LinkedIn and on Avvo.com where you may also read client endorsements and reviews.


What can the innocent doctor do when audited for drug diversion?

At all ages, there are people who will abuse prescription narcotics one way or another. Some abuse narcotics, causing danger to themselves, and others sell or give them to others, contributing to danger and illegality. When someone goes to the doctor, presenting a condition requiring pain medication, for example, the doctor has no idea or control regarding what the patient can and will do after they leave to get their prescription filled and are on their way. If the patient has a temporary condition that never seems to get better, or despite all reasonable pain management efforts, the patient still needs narcotics, there could be a greater underlying problem such as drug diversion.

What is drug diversion?

Drug diversion is the taking and giving, selling or otherwise using prescribed, controlled narcotics for any purpose other than that which the physician wrote the prescription. State and federal investigators and their agencies have charged many physicians with criminal violations in connection with drug diversion. While some may be guilty as charged and making money off drug diversion, others may be unknowing victims of the bad acts and schemes of others, within and beyond the healthcare facilities and systems within which they practice.

The drug diversion statistics and information collected and shared in the health care community are compelling. As new “tricks of the trade” are discovered, so are more examples of diversion behavior. A 2013 drug diversion awareness conference presentation highlights DEA perspectives on pharmaceutical use and abuse.

How can a physician know if their patient may be engaged in drug diversion?

No matter what the honest physician, assistants and staff do to prevent drug diversion, it may be impossible to spot every bad actor.

Awareness and education are key tools in combatting drug diversion. Not only must prescribing physicians pay attention to this problem, their nurses, staff and those at the pharmacy or dispensing authority should all be part of the conversation and sharing of information when something or someone just does not seem right. Pain medication tracking systems and new technologies make it easier to monitor narcotics and the patients to whom they are prescribed. Despite all the education, awareness and tracking efforts, drug diverters can still slip between the cracks, exposing the physician to liability.

Liability concerns and fear of investigations are making many physicians more careful, but some say they are too careful. Patients with legitimate needs for high-dose of powerful pain narcotics might be denied the painkillers they need to not be in chronic pain, because that patient’s history and prescriptions could trigger an audit in an electronically monitored system.

What can a physician do if they are targeted and accused of running a “pill mill?”

Under a federal standard, physicians face criminal liability if they prescribe controlled narcotics without a “legitimate medical purpose” and outside the “usual course of his professional practice.[i]” State standards vary from one to the next, some being higher than others.

In Illinois, the Medical Practice Act of 1987 enumerates the laws of the State of Illinois with respect to physicians and physician assistants and their legal duties and restrictions with respect to prescribing controlled narcotics. In addition to criminal liability, the Act specifically identifies grounds for discipline by the state for “Prescribing, selling, administering, distributing, giving or self-administering any drug classified as a controlled substance (designated product) or narcotic for other than medically accepted therapeutic purposes.[ii]

If federal or state investigators receive a tip or independently “audit” (investigate) your practice with a search warrant, they may already suspect there is a violation of law and they simply want proof to charge the physician with crimes. At the very first moment a physician senses or is notified of an audit or investigation of their practice and prescription histories, the physician should immediately contact an experienced healthcare law and licensing attorney with a criminal defense focus.

Michael V. Favia & Associates, P.C. represents Illinois-licensed professionals in actions involving the IDFPR and the federal and state agencies investigating and prosecuting for drug diversion. Physicians are well-advised to obtain proactive advice and counsel to make sure they are well-protected.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent licensed physicians in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, please call (773) 631-4850, visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

[i] U.S. DOJ, Office of Diversion Control, Purpose of issue of prescription, 21 C.F.R. § 1306.04(a)

[ii] Illinois Medical Practice Act of 1987, 225 ILCS 60/22 (A)(17).

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Prescription theft and abuse: What physicians can do to prevent prescription drug diversion

The best practices and preventative measures physicians take to prevent the theft and abuse of prescriptions may help them protect their medical license and practice.

The best practices and preventative measures physicians take to prevent the theft and abuse of prescriptions may help them protect their medical license and practice.

Prescription theft and abuse is a serious problem posing a threat to physicians. The problem is the diversion of drugs from legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary. The Drug Enforcement Agency (DEA) along with federal and state groups are charged with the duty of regulating prescription drug diversion and prescription theft and abuse. The significant efforts to increase security in prescription practices include new technologies and practices physicians and can implement to protect themselves and their practices from prescription drug diversion. There are several practice tips physicians can adopt to safeguard against prescription theft and abuse.

Prescription drug diversion is a vast and serious national health problem.

The Centers for Disease Control and Prevention calls drug diversion an “epidemic.” Many professionals recognize drug diversion as one of our nation’s fastest growing health problems. Prescription drug abuse is the main problem. The Office of Inspector General (OIG) investigates prescription drug diversion and reports that the black market sale of prescription drugs is very lucrative. “OIG agents report that a bottle of 30mg Oxycodone tablets are trafficked at a price of $1100 – 2400 a bottle! This is up to 12 times the normal price of a legally filled script.[i]

Prescription monitoring programs allow physicians and pharmacists to share information tracking prescriptions and counteract drug diversion.

Prescription monitoring programs (PMPs) are state-administered programs to collect and distribute data about the prescription and dispensing of federal controlled drugs. PMPs assist physicians and the members of their practice, physician assistants, nurse practitioners and licensed prescribers. The pharmacies dispensing controlled substances register and report to the PMPs to track prescriptions and share information so a prescribing physician can be alerted if prescriptions are being filled that the physician never authorized in the first place. There are several ways drug diverters produce fraudulent prescriptions.

Paper prescriptions must contain security features and there are suggested safe tracking procedures.

The traditional paper prescription pads are easy enough to steal from a physician’s office. The Centers for Medicare and Medicaid Services (CMS) requires prescription pads are compliant with the rules that they use security features to prevent copying or counterfeiting of physician prescription pads.[ii]

There are additional risk management tips and protocols to manage paper prescription theft and abuse[iii]:

  • “Request notifications from local pharmacies before prescriptions for controlled substances are dispensed.
  • Use the control batch number on each script to track the order of prescriptions.
  • Require patients to visit the office to obtain prescriptions for controlled medications.
  • Note actual amounts prescribed, and give matching numerals to discourage prescription alterations (e.g., thirty/#30).[iv]

E-prescriptions and technology tracking the prescriptions can alleviate concerns of traditional paper pad prescriptions.

Electronic  prescribing (e-prescriptions) can be effective in decreasing the opportunity for prescription theft and abuse. It is easy and efficient to track prescriptions using electronic prescribing software technologies. E-prescriptions reduce the threat of prescription theft and alterations while increasing the physician’s direct access to the pharmacists filling prescriptions to make sure the process of filling prescriptions is accurate.

Safe prescription plans can help physicians reduce their liability for drug diversion.

The best practices and preventative measures physicians take to prevent the theft and abuse of prescriptions may help them protect their medical license and practice. With insurance companies, state and federal agencies all requiring additional security and practices to prevent drug diversion, physicians have an increased duty to maintain their prescription practices. The consequences of negligence could include loss of privileges, criminal and civil liability, and professional discipline.

Michael V. Favia is a lawyer representing and defending health care professionals in legal and professional licensing concerns. Michael V. Favia & Associates offices are conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] Office of Inspector General website, Spotlight On… Drug Diversion

[ii] Centers for Medicare & Medicaid Services, Tamper Resistant Prescriptions.

[iii] The Doctors Company, Are Your Prescribing Practices Secure?

[iv] See HNiii above