Byron Tau and Aruna Viswanatha in the Wall Street Journal: “When federal investigators got a tip in 2015 that a health center in Houston was distributing millions of doses of opioid painkillers, they tried a new approach: look at the numbers.
State and federal prescription and medical billing data showed a pattern of overprescription, giving authorities enough ammunition to send an undercover Drug Enforcement Administration agent. She found a crowded waiting room and armed security guards. After a 91-second appointment with the sole doctor, the agent paid $270 at the cash-only clinic and walked out with 100 10mg pills of the powerful opioid hydrocodone.
The subsequent prosecution of the doctor and the clinic owner, who were sentenced last year to 35 years in prison, laid the groundwork for a new data-driven Justice Department strategy to help target one of the worst public-health crises in the country. Prosecutors expanded the pilot program from Houston to the hard-hit Appalachian region in early 2019. Within months, the effort resulted in the indictments of dozens of doctors, nurses, pharmacists and others. Two-thirds of them had been identified through analyzing the data, a Justice Department official said. A quarter of defendants were expected to plead guilty, according to the Justice Department, and additional indictments through the program are expected in the coming weeks.
“These are doctors behaving like drug dealers,” said Brian Benczkowski, head of the Justice Department’s criminal division who oversaw the expansion.
“They’ve been operating as though nobody could see them for a long period of time. Now we have the data,” Mr. Benczkowski said.
The Justice Department’s fraud section has been using data analytics in health-care prosecutions for several years—combing through Medicare and Medicaid billing data for evidence of fraud, and deploying the strategy in cities around the country that saw outlier billings. In 2018, the health-care fraud unit charged more than 300 people with fraud totaling more than $2 billion, according to the Justice Department.
But using the data to combat the opioid crisis, which is ravaging communities across the country, is a new development for the department, which has made tackling the epidemic a key priority in the Trump administration….(More)”.