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www.urxnet.org. www.ifd.utah.gov. Advanced Pain and Weight Management. In approximately March of 2004 Theodore opens Advanced Pain and Weight Management. Board Certified in Pediatric Medicine Multi-Million dollar practice in Tulsa, Oklahoma “issues” in Oklahoma. Moved to Utah

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www.urxnet.org

www.ifd.utah.gov


Advanced pain and weight management
Advanced Pain and Weight Management

  • In approximately March of 2004 Theodore opens Advanced Pain and Weight Management.

  • Board Certified in Pediatric Medicine

  • Multi-Million dollar practice in Tulsa, Oklahoma

  • “issues” in Oklahoma. Moved to Utah

  • Worked for two different “Medical-Mills”

  • Rent-a-doc

  • Search warrant served on last employer

  • No certification in pain management

  • “member” of Pain Management Association

www.urxnet.org

www.ifd.utah.gov


Dr alexander theodore

Dr. Alexander Theodore

“I am a one prescription doctor”

“If there is a forest fire, I don’t send in the boy scouts to piss on it”

www.urxnet.org

www.ifd.utah.gov


Java jims coffee and narcotic distribution shop
Java Jims Coffee and narcotic distribution shop

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www.ifd.utah.gov


The insurance fraud
The Insurance Fraud

  • The average cost of a 120 tablet OxyContin 40mg prescription was $560

  • State Medicare and almost every big insurance carrier was billed and paid for the scripts

  • Estimated insurance loss was close to $400,000.00

  • Off a $15 to $20 co-pay, participants made close to $3,000.00 per prescription.

www.urxnet.org

www.ifd.utah.gov


The indictment
THE INDICTMENT

  • On 5/4/06 Alexander Theodore was indicted on 83 Federal Counts.

  • A Warrant was issued for his arrest and he was arraigned before a US Magistrate on 5/5/06

  • Continuing Criminal Enterprise

  • Conspiracy to Distribute a CS

  • 22 Counts of OxyContin Distribution

  • Falsification of Information in Health Care Matters

  • Fraud Against the United States

  • Aggravated Identity Theft

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www.ifd.utah.gov


Alexander theodore oxycontin comparison prescriptions doses
Alexander Theodore OxyContin Comparison. # Prescriptions # Doses

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Org chart
Org Chart

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Dr theodore
Dr. Theodore

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www.ifd.utah.gov


Dr. 1

  • 2005-2007

    • Multiple complaints file at Licensing (DOPL) by pharmacists & family members of OD victims.

  • Late 2006-Early 2007

    • DEA notified

  • Early 2007

    • Salt Lake County seeing DUI and drug arrests with suspects linked to Dr. 1.

  • April 2007

    • IFD asked to prosecute case due to our experience with Theodore.

  • May 16, 2007

    • Records Seized and interviews followed for several months.

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www.ifd.utah.gov


What we learned
What We Learned

  • Over 4,000,000 Doses written by Dr. 1 in four

    year period.

  • Multiple over doses in 18 month period

  • 18 deceased patients in same time period

  • Over $1,000,000 billed to insurance carriers in 18

    months

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www.ifd.utah.gov


Dr. 1

  • $182-200 office visit 80% 90% cash

  • $66-70 follow-up visit

  • 3-6 hour wait

  • 4.2 million pills

  • 45000 prescriptions in 48 months

  • Street price per pill went up $30-40 overnight

  • Pharmacy robberies went up

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www.ifd.utah.gov


Indictment
Indictment

December 12, 2007

18 federal counts

11 Distribution of a controlled substance

5 Counts of distribution resulting in death

5 Counts insurance fraud

1 Count Money Laundering

1 Count conspiracy

Two Office staff indicted on conspiracy

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www.ifd.utah.gov


Dr. 2

Davis County Physician

  • Lost job at clinic

  • Divorce

  • Several complaints concerning meeting patients in their cars

  • UC

  • Buys

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www.ifd.utah.gov


Indictment1
Indictment

Dr. 2 was indicted on 2 counts of unlawful distribution of a controlled substance (federal)

Following indictment- discovered 6 deceased patients. Reviewing case to determine additional counts.

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www.ifd.utah.gov


We re number one
We’re Number One!

  • 2007 study by U.S. Department of Health and Human Services:

  • “Utah leads the nation in non-medical painkiller abuse.”

  • 6.5 percent of Utahns are using prescription drugs without a doctor's approval. That is over 150,000 people.

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www.ifd.utah.gov


We re number one1
We’re Number One!

  • Between 1992 & 2003

  • The U.S. population grew 13 %

  • Rx drug abuse rose 93.8%

  • The number of prescriptions for narcotic pain killers soared to 222%

  • In 1992 insurance paid for 26% of Rx drugs

  • In 2005 insurance paid for 50% of Rx drugs

  • Pain Management has emerged as a legitimate medical specialty.

  • This has encouraged wider use of prescription narcotics.

  • Because pain management is largely unregulated, any doctor can designate himself as a pain management specialist.

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www.ifd.utah.gov


What are the costs

For every $1.00 insurance pays in narcotic prescription costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

What are the costs?

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www.ifd.utah.gov


Health care fraud caseload
Health Care Fraud Caseload costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

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www.ifd.utah.gov


Doctor shopping
Doctor Shopping costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

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www.ifd.utah.gov


Drug deaths
DRUG DEATHS costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

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www.ifd.utah.gov


Drug Death Increases costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

859% Increase!!!

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Doctor shoppers
Doctor Shoppers costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

FY2005 - 2006

>= 12 Prescribers – 1,878 individuals

>= 24 Prescribers – 160 individuals

Age range – 18 years old to 60 years old

Average age 34

Gender Ratio: 66% female/34% male

Average number of Rxs - 70

Average number of prescribers - 32

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www.ifd.utah.gov


T s rph
T. S. RPh. costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

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www.ifd.utah.gov


T s pharmacist
T. S. Pharmacist costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • Charged insurance co. $26k for diverted pharmaceuticals.

  • Arrested on insurance fraud and witness tampering.

  • One month in jail. Restitution. Fine.

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www.ifd.utah.gov


Ifd task force participation
IFD Task Force participation costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • Identity Fraud (FBI)

  • Mortgage Fraud (FBI)

  • Healthcare Fraud (FBI)

  • URxNet working group (IFD)

  • Financial Crimes

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www.urxnet.org

www.ifd.utah.gov


Rank Drug Type Deaths 1998-2005 costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

1 Oxycodone Prescription opioid painkiller* 5548

2 Fentanyl Prescription opioid painkiller* 3545

3 Clozapine Antipsychotic 3277

4 Morphine Prescription opioid painkiller* 1616

5 Acetaminophen Over-the-counter painkiller 1393

6 Methadone Prescription opioid painkiller*/addiction medication 1258

7 Infliximab Immune-system modulating drug 1228

8 Interferon beta Immune-system modulating drug 1178

9 Risperidone Antipsychotic 1093

10 Etanercept Immune-system modulating drug 1034

Source: Moore TJ et al., Serious Adverse Drug Events Reported to the Food and Drug Administration, 1998-2005, Archives of Internal Medicine, Sept. 10., 2007; 167 (16): 1752-1759

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www.ifd.utah.gov


Types of Drugs that are Diverted costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • Lortab/Hydrocodone/Norco

  • Oxycodone/Percocet/Roxicet

  • Oxycontin

  • Ambiem

  • Actiq

  • Hydromorphone

  • Alprazolam/Xanax

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www.ifd.utah.gov


Utah csdb reports
Utah CSDB Reports costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

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Prosecution how many charges per script
PROSECUTION: costs, it pays out $41.00 in related medical claims in doctor-shopping cases.How Many Charges per Script

One Forged prescription carries the following counts

  • Could be two counts of Felony ID theft

    • One count doctor

    • One count patient

  • Forgery

  • Illegal Possession controlled substance

  • Insurance fraud

  • Communications fraud

  • Practicing Medicine w/o License

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www.ifd.utah.gov


Utah’s Problem costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

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www.ifd.utah.gov


Other Cases involving Diversion of Prescription Drugs costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

D. A., MD 588 Felony counts possible

Oxycontin scripts

Insurance Paid $97,000

P. C. Pharmacy

T. S., R.Ph billed meds for wife to GF Insurance

Bribed her to assist with hampering investigation

C. D. and S. S.

29 priors

bought Percocet $40.00

Oxycontin

K. B. Elementary Teacher

650-800 Ambien monthly

Shopping for meds

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So, How are these drugs Diverted? costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • Stolen from pharmacy/shipping

  • Stolen from home (Kids)

  • Obtained falsely (lie to doc)

  • Forgery

  • Robbery

  • Pharmacy insider

  • Physician/staff

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www.ifd.utah.gov


What is the Goal? costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • To terminate the behavior

    • Saves money

    • Stops the diversion

    • Helps control addiction

  • Arrest

    • Treatment

    • Drug testing

    • Restitution

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www.ifd.utah.gov


www.urxnet.org costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

www.ifd.utah.gov


HIPAA? costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • HIPAA does not apply when reporting diversion or a

    suspected violation of the law.

  • HIPAA was originally created for malicious misuse

  • NO PROSECUTION for good faith release of

    information

  • NO PROSECUTION for release to law enforcement.

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www.ifd.utah.gov


Contact Numbers costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

  • Poison Control 1-800-222-1222

  • Personal Physician

  • Local Police

  • Insurance company (run your own script

    histories, no EOB on drugs)

  • Insurance Fraud Division 801-531-5385

  • Utah Controlled Substance DB 801-530-6220

  • Treatment Programs

  • www.ifd.utah.gov

  • www.urxnet.org

www.urxnet.org

www.ifd.utah.gov


QUESTIONS? costs, it pays out $41.00 in related medical claims in doctor-shopping cases.

THANK YOU!

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www.ifd.utah.gov


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