The escalating heroin crisis has roots in healthcare fraud

Special report: Homegrown fraud task forces promote collaboration

By all appearances, Portland, Maine, is an idyllic setting. Despite the notoriously brutal winters, thousands of tourists flock to the small seaside city in the summer months to take in the state's rocky coast, lie on the sandy beaches, or enjoy a fat, red lobster on one of the city's piers.

With its quant, brick-lined streets, Portland does not present itself as a city in the midst of a crippling heroin epidemic.

I moved to Portland less than a month ago, and within weeks it became strikingly clear that heroin addiction is a powerful undercurrent within the small city and its suburbs. What's less apparent to many is the fact that the heroin crisis currently gripping the country is inextricably tied to prescription drug fraud. 

In July, the Washington Post published a long exposé on how the heroin crisis had affected Falmouth, Maine, an affluent suburb of Portland, where a 29-year-old man died of a heroin overdose. On the day of his funeral, his step-brother nearly met the same fate.

Less than two weeks after the article was published, Portland saw 14 overdoses within a 24-hour period, the Portland Press Herald reported. Public health officials later raised concerns that some of those overdoses could be linked to "bad batches" of heroin containing fentanyl, a drug 50 times more potent than heroin.

Of course, Portland is not alone. Other areas of the country including, Pittsburgh, small towns in Pennsylvania, Orange County, Florida, Baltimore, and rural areas of New Hampshire and Vermont are experiencing similar problems with heroin overdoses. Earlier this year, the Centers for Disease Control and Prevention revealed that heroin-related deaths have quadrupled from 2002 to 2013. From 2012 to 2013 alone, deaths involving heroin increased 39 percent.

It's clear that heroin addiction is indiscriminate when it comes to location, race or socioeconomic status. That's because heroin addiction frequently derives from an addiction to opioids that anyone--black, white, rich or poor--can legally acquire at the doctor's office. Forty-five percent of people who abused heroin were also dependent on prescription painkillers, according to the CDC.

At one time those drugs were easy to acquire--almost too easy. Then supply plummeted and prices jumped, but by that time too many people were addicted to opioids to stop cold turkey. Instead, they turned to heroin, which offered the same high with a cheaper price tag.

The country's addiction to painkillers can be traced back, in large part, to two decades worth of overprescribing. Some of that was perpetrated by well-meaning physicians, looking to provide a measure of pain relief for their patients, but unaware of the potential consequences. However, at least a portion of the growth in opioid addiction takes root in "pill mills" and prescription drug fraud schemes that profit on the backs of addicts.

It's a trend that was hidden in plain sight, and fueled by the money that can be made on narcotics, either on the black market or by simply filing an insurance claim. Insurers pay up to $72.5 billion each year in healthcare costs related to non-medical use of prescription painkillers, and fraud enforcement officials routinely uncover schemes in which physicians have written prescriptions for unnecessary narcotics as a conduit to Medicare reiumbursement.

In May, a New York man was found guilty of operating an oxycodone distribution ring that doled out more than 5 million pain pills. In June, a Connecticut advanced practice registered nurse pleaded guilty to inappropriately prescribing a pain medication intended for cancer patients after receiving kickbacks from the pharmaceutical company.

On a larger scale, PharMerica recently paid $31.5 million to settle allegations that it routinely dispensed Schedule II drugs without a written prescription. Just two days ago, a Detroit physician pleaded guilty to a $5.7 million fraud scheme in which he lured patients to his clinic with unnecessary painkiller prescriptions, and then billed Medicare for a slew of other unnecessary tests and office visits to make it seem as though it was all legitimate.

However, the stakes are getting higher. Yesterday marked the beginning of a trial against Dr. Hsiu-Ying "Lisa" Tseng, who is facing murder charges for indiscriminately writing painkiller prescriptions that prosecutors allege led to the death of three young men, according to the Washington Post. Prosecutors say Tseng ignored previous reports that her patients were dying of opioid overdoses. In Florida, Gerald Klein, M.D., faces murder charges for overprescribing hydromorphone pills that led to the death of a 24-year-old addict, the Sun-Sentinel reports.

Make no mistake, the current heroin epidemic in this country is a multi-faceted problem born from a confluence of factors, including a lack of drug treatment options for addicts, a surge of cheap heroin coming in from the Mexican drug cartel, and several decades' worth of prescribing pain pills.

But fraud schemes play an important role within the supporting cast that contributes to heroin addiction, and a nationwide crisis that is becoming frighteningly apparent. Only now are we beginning to trace the line from prescription drug fraud to widespread opioid addiction that is ravaging entire communities.

For fraud investigators, it's an important reminder that there is more at stake than just dollars and cents. That direct connection may not be readily apparent, but the work that goes into uncovering widespread prescription drug fraud schemes has a reverse domino effect. Maybe you can't pick up all the pieces, but you can prevent more from falling down.

For cities like Portland, and others around the country rocked by a groundswell of heroin addiction, stopping unnecessary prescriptions could be the difference between life and death. - Evan (@HealthPayer)