How are Prescription Fraud Cases Investigated in Michigan?

Michigan doctors are under heightened risk of prosecution for prescription fraud.  This is because Michigan, and specifically the Eastern District of Michigan, has been identified as one of the top 12 places in the Country for opioid fraud and abuse. For this reason alone it’s important for Michigan doctors to be aware of how prescription fraud cases are identified and prosecuted.

Broadly speaking, prescription fraud is committed when someone fraudulently obtains prescription drugs. The fraud can be committed in various ways. For example, there have been cases in which doctors wrote fake prescriptions for pain killers and gave the scripts to a “runner.” The runner then takes the scripts to a knowing or unknowing pharmacy for the prescription to be filled. In these cases, the drugs are typically re-sold on the street at a very high markup. The funds are then distributed back up the chain.

Another example comes from a recent prescription fraud case in Michigan. In this case, two men worked together. One would impersonate a doctor and call a prescription into a pharmacy. The two men then drove to the pharmacy and the other would go in and try to obtain the prescription drugs.

Who investigates prescription fraud cases in Michigan?

Investigations for prescription fraud can be handled by several different agencies between federal and state agencies. The Department of Justice has a division called the Healthcare Fraud Unit (HCF) devoted solely to investigating these cases and others within healthcare fraud. The HCF has a a multi-agency focus. Prosecutors and agents within the HCF work in conjunction with the DEA, FBI, Department of Homeland Security, and state-level law enforcement to conduct investigations. At the federal level, prosecutors and detectives from these agencies would handle an investigation of prescription fraud.

Michigan also has its own statutes prohibiting obtaining prescription drugs (controlled substances) fraudulently. Cases may state at the state level and won’t involve federal agencies if they involve a very small amount of drugs and a very few amount of people involved.

How are prescription fraud investigations initiated?

Prescription fraud cases can be initiated by defendants caught with controlled substances who become informants, healthcare professionals who report wrongdoing to law enforcement, or insurance companies who notice irregularities and report them to law enforcement.

Another very common way prescription fraud cases are initiated these days is through the computerized record keeping system. Federal or state agents may do an audit and notice that a medical practice or pharmacy is issuing way too much of a particular kind of drug for a practice of that size or specialty. Detectives will base industry standards on specialties. Pain clinics will commonly issue more pain pills as opposed an OBGYN practice. Agents would then look at records of the pharmacy or medical practice to see whether particular patients are receiving too much a particular drug. They could also send undercover operatives to try to collect information and see if they can replicate the illegal prescriptions.

Clinics, physicians, and pharmacists should not be outside the norms of industry practice. Healthcare and pharmacy professionals should keep detailed exam notes, copies of proofs of insurance, copies of prescriptions filled, copies of drivers’ licenses for patients, and up-to-date DEA and pharmaceutical licenses.

What kind of evidence is sought?

There are a few categories of evidence collected in prescription fraud cases. Below is a list of some commonly collected evidence in these cases:

• Physical evidence: the actual drugs, prescription slips, papers and documents from doctors’ offices and pharmacies
• Testimonial evidence: statements by defendants and witnesses collected from interviews with detectives
• Electronic evidence- prescriptions records from the issuing physician and the pharmacy; records from the Michigan Automated Prescription System (MAPS) that tracks controlled substances like oxycodone, noroc, adderrall, etc.; audio recordings from wire taps
• Evidence that shows that a pharmacists or doctor is getting paid more based on how many prescriptions are filled or to act in compliance with the scheme to commit prescription fraud

As you can see, prescription fraud cases can be highly complex. They often require a much more significant time investment than the typical misdemeanor or felony case in state court. The prescription fraud lawyers at the Barone Defense Firm have the experience, expertise, and care to make real differences in these cases. If you need help with a prescription fraud case in Michigan, do not hesitate to call us today for a consultation.