Federal Prosecutors Issue Warning to Wisconsin Providers about Their Opioid Prescribing Practices (Part 2 of 5 Part Series)

Wednesday, March 6, 2019
George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Please Note: This is part two of five in a blog series. This blog will attempt to discuss how the action by the Wisconsin prosecutors contradicts the Alaska Board of Pharmacy Letter. Click here to read part one and here for part three of this blog.

On February 5, 2019, federal prosecutors warned 180 Wisconsin doctors, physician assistants and nurse practitioners that they have been prescribing more painkillers than their peers. U.S. attorneys for Eastern and Western Districts of Wisconsin announced that letters have been sent to prescribers cautioning them about their opioid prescribing practices. These notification letters are part of a broader federal and state effort to reduce the number of people becoming addicted to opioids.

Although these letters were not aimed at pharmacists and pharmacies, there is no reason that they should believe that they will be treated any differently if they fill prescriptions for painkillers that doctors, physician assistants and nurse practitioners write.  In fact, they should count on it as they are in the same boat. We can tell you from our experiences that the Drug Enforcement Administration (DEA) and federal prosecutors will not allow pharmacists and pharmacies to us the fact that knowledgeable, experienced medical professionals, who know the patient's medical condition best, have written the prescriptions. They expect the pharmacists to second guess the medical professionals and interpose their judgment. Caught between a rock and a hard place, many pharmacists either stop filling prescriptions for opioids altogether or just lie to the patient and tell the patient that they are out of the medication.


Prescribing Opioids at High Levels.

U.S. attorneys said they sent letters to over 180 physicians, physician assistants, and nurse practitioners in Wisconsin. The letters notified the providers that a recent review of their prescribing practices showed that they were prescribing opioids at high levels compared to other prescribers.

“Although the letters acknowledge that the prescriptions may be medically appropriate, they also remind the practitioners that prescribing opioids without a legitimate medical purpose could subject them to enforcement action, including criminal prosecution,” said U.S. attorneys.

Click here to read the Press Release in full.


Wisconsin’s Updated Opioid Prescribing Guidelines.


As part of the effort to prevent opioid abuse, Wisconsin’s Medical Examining Board issued new guidelines for prescribing opioids on January 16, 2019. You can see a copy of the new guidelines here.


A Contradiction Between the Two Letters?


In part one of this blog, I discussed the letter sent to pharmacists in Alaska discussing the negative effect on patient health in response to the fact that many pharmacists stopped filling prescriptions for opioids.  From its tone, it warns pharmacists to keep filling such prescriptions under threat of possible disciplinary action against their licenses, or at least that is my interpretation of it.  Here is a copy of the letter you can read for yourself, click here.

Click here to read part one of the blog if you haven’t already or need a refresher.
The Alaska Board of Pharmacy Letter from part one and the Wisconsin opioid prescribing letter seem to be a stark contrast of each other.

The Alaska Board of Pharmacy letter appears to be trying to convince pharmacists to fill more prescriptions for opioids and gives them proper reasons to do so.  The letter seems to urge them to establish “relationships” with opioid writing physicians, and even issued “following guidance and reminders.”  The letter even appears to threaten disciplinary action against Alaska pharmacists when it states, “As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation.”

The goal of the letter put out by Wisconsin prosecutors is to actively warn providers that they have been prescribing opioids at higher levels than their peers. Additionally, the letter appears to actively threaten prosecution or disciplinary action of those that write and fill opioid prescriptions without a legitimate medical purpose.

The letter put out by Wisconsin prosecutors also list resources that the prescribers can use. It urges practitioners to take stock of their prescribing practices and acquaint themselves with guidelines for safe and legal opioid prescribing. It also reminds prescribers that Wisconsin law requires the use of the Wisconsin Prescription Drug Monitoring Program to assess patients’ prescription histories before prescribing narcotic drugs.

To read my additional opinions on the types of actions that can be taken by states and state agencies to address the issues which the Alaska Board letter attempts to address, please see Part 1 of this blog.  To learn more on administrative and informal hearings before the Florida Board of Pharmacy, click here.

In 2018, the state of Florida sued Walgreens and CVS for their alleged role in helping create and increase the opioid crisis, following a DEA investigation. Click here to read my prior blog.


Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.


The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The Firm also represents both plaintiffs (whistle blowers or relators) and defendants in False Claims Act (whistle blower or qui tam) cases. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Sources:

Veilmetti, Bruce. “Feds warn 180 Wisconsin health care professionals about overprescribing opiates.” (Milwaukee Journal Sentinel). (February 5, 2019). Web.

Friese, Melanie. “Federal prosecutors warn Wisconsin health professional about overprescribing opiates.” ABC WKOW 27News. (February 7, 2019). Web.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.


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3/6/2019

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