Vernon Stejskal

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Building Cases Across State LinesNational Rx Drug Abuse Summit 4-10-12


<ul><li> 1. Building CasesAcross State Lines April 10-12, 2012Walt Disney World Swan Resort </li> <li> 2. Learning Objectives:1) Evaluate the roles of practitioners, regulatory authorities, state and federal investigators and prosecutors in pharmaceutical drug crime cases, with an emphasis on how individuals and agencies can collaborate to achieve common goals.2) Describe the evolution of the prescription pill epidemic and outline the uses and limitations of prescription drug monitoring programs to aid in multi-state investigations.3) Identify problem areas and common roadblocks to effective multi-state investigations from a prosecutors perspective, with a discussion of the prosecutors role in working with the investigator in early case development. </li> <li> 3. Disclosure Statement All presenters for this session, Agent Bruce DiVincenzo and AAG Vernon Stejskal, have disclosed no relevant, real or apparent personal or professional financial relationships. </li> <li> 4. Medical Practitioners They are Law Enforcement partners, not adversaries, in most instances, such as in cases of doctor shopping and prescription fraud Like lawyers and police, the worst 1% give the profession a bad reputation On the front lines first hand observation of addiction/drug- seeking, and first ones with the ability to do something As an investigator, make friends with at least one pharmacist or medical provider who will take your calls and answer questions dont use that person as a witness, and dont overload them </li> <li> 5. Medical Practitioners One of the first things to do in every investigation is to determine who is the problem/target. Is it the doctor, someone working in the doctors office, or the patient? That determination will effect how records are requested from a medical practitioner. </li> <li> 6. Medical PractitionersHIPPA does not prohibit sharing patientinformation with law enforcementThere are a number of exceptions that permit law enforcementofficials to access protected health information. These exceptionsbypass the requirement that the individual consent or be given anopportunity to decide whether his or her protected healthinformation will be disclosed.Crime on premises: If a covered entity believes in good faith thatprotected health information is evidence of criminal conduct thatoccurred on the premises of the covered entity, it may disclosethe information to a law enforcement official. </li> <li> 7. Medical PractitionersMay require a subpoena to obtain patientinformationRestricted access for administrative requests: An administrativesubpoena may be used to obtain protected health information.In order to use an administrative subpoena, however, thefollowing criteria must be met:1)the information sought must be relevant and material to alegitimate investigation,2)the request must be specific and limited in scope to meet itsintended purpose, and3)information that does not reveal the individuals identity couldnot reasonably be substituted for the information sought. </li> <li> 8. Medical Practitioners Most medical practitioners are willing to cooperate with law enforcement as long as they wont get into legal trouble over confidentiality The ones that arent cooperative may have something to hide themselves </li> <li> 9. Medical PractitionersCheck the PDMPMedical providers should check theControlled Substance Database tosee whether a patient is getting anycontrolled substances from any othersource before prescribing controlledsubstances to that person. Adatabase check is not a legalrequirement, but is stronglyencouraged. </li> <li> 10. Medical Practitioners The second doctor is NOT prohibited from prescribing controlled substances. Rather the law is intended to allow doctors to make informed decisions on whether controlled substances are medically necessary, and to avoid unintentional overprescribing and/or addiction. We are not in the business of making medical decisions. </li> <li> 11. Medical Practitioners People starting out with legitimate injuries or pain issues become dependent or addicted and become doctor shoppers seeking more pills. No informed consent to patients that controlled substances can be addictive and have unwanted side-effects. Are unscrupulous or untrained doctors creating addicts? </li> <li> 12. Regulatory Authorities In Utah, the Division of Professional Licensing (DOPL) investigates professionals and grants or denies, suspends, revokes, or places limitations on medical/ pharmacy professionals licenses The Drug Enforcement Administration (DEA) grants or denies, revokes, suspends, or places limitations on controlled substance prescribing/dispensing registration </li> <li> 13. Regulatory Authorities Even if a criminal charge cannot be filed, at times a licensing action, Controlled Substance registration restriction, or civil fine can be imposed on medical professionals who are in violation of the applicable requirements </li> <li> 14. State Investigators Use State PDMPs Build partnerships with Pharmaceutical drug crime investigators in neighboring states Assist other investigators within the limits of your state PDMP </li> <li> 15. State Prosecutors Work with officers in the investigation stage Dont wait for a prosecution packet and then decline to prosecute because something is weak or missing. Dont be afraid to contact federal prosecutors if a case involves jurisdictional issues which make it difficult to prosecute in a state district court. </li> <li> 16. Federal Investigators Concentrate on the cases involving large scale drug diversion, and cases that cannot be prosecuted in a single state or county because of jurisdiction/venue issues If resources are limited, focus on the most egregious offenders. Successful prosecution may have a deterrent effect. </li> <li> 17. Federal Prosecutors Break down state boundaries, like we do in other drug cases. Charge a conspiracy when applicable. Work with officers on the investigation, making sure everything necessary for prosecution is obtained. </li> <li> 18. Prescription Drug Monitoring Programs (PDMPs) According to the Alliance of States with Prescription Monitoring Programs, ( as of October 16, 2011, 37 states have operational PDMPs that have the capacity to receive and distribute controlled substance prescription information to authorized users. States with operational programs include: Alabama, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, and Wyoming. </li> <li> 19. Prescription Drug Monitoring Programs (PDMPs) Eleven states (Alaska, Arkansas, Delaware, Georgia, Maryland, Montana, Nebraska, New Jersey, South Dakota, Washington, andWisconsin) and one U.S. territory (Guam), have enacted legislation to establish a PDMP, but are not fully operational. If your state doesnt have one, make it priority #1 to get one. Each state designates a state agency to oversee its PDMP, which may include health departments, pharmacy boards, or state law enforcement. The Alliance of States with Prescription Monitoring Programs maintains a list of state contacts. </li> <li> 20. UTAHs PDMP Anyone licensed to prescribe a controlled substance is required to register with DOPL to use the database Failure to comply is grounds for refusal to issue or renew a license, or to revoke, suspend, restrict, or place on probation, any license </li> <li> 21. UTAHs PDMP Access is given to: DOPL investigators Dept. of Health Licensed Practitioners with CS privileges (and designated employees) Licensed Pharmacists Law Enforcement (and Prosecutors) oAssigned to investigate drug crimes oInsurance Fraud + Medicaid/Medicare Fraud </li> <li> 22. UTAHs PDMP Pharmacies are required to report information to the database every 7 days Patient name and address Prescribing physician Dispensing Pharmacy &amp; Date Filled Drug, # of pills, and duration of Prescription </li> <li> 23. PDMP Uses All of the information for each state is compiled in an easily accessible place Can track multi-state activity using your computer, fax, and telephone No prohibitions on sharing information with other law enforcement working jointly on a case </li> <li> 24. PDMP Limitations Each state maintains their own info and imposes different restrictions on access know the rules Information in PDMPs is not evidence Investigators must obtain the prescriptions from the reporting pharmacies </li> <li> 25. Jurisdictional Issues Have drug enforcement agents conducted multi-state investigations involving other drugs? What makes pharmaceutical drug crimes different? No PDMP database for meth, heroin, or cocaine Old fashioned investigation Physical surveillance GPS tracking Telephone interception Confidential Sources/Cooperators Confessions </li> <li> 26. Jurisdictional Issues Any offense begun in one jurisdiction and completed in another, or committed in more than one jurisdiction, may be inquired of and prosecuted in any jurisdiction in which such offense was begun, continued, or completed 18 U.S.C. 3237 Look for federal charges such as Conspiracy or Medicaid/Medicare Fraud which can be charged in any state where some of the charged activity occurred </li> <li> 27. Jurisdictional Issues Cooperate with law enforcement partners in other states Help them, theyll help you. Stone wall them, guess what you can expect in return. Use DEA Diversion as a resource. They have expertise on Internet cases and have a form on their website. </li> <li> 28. Pill Mills In order to be legal, a controlled substance prescription must: Be issued by a registered practitioner Be for a legitimate medical purpose Be issued in the usual course of professional practice </li> <li> 29. Pill MillsModel Policy for the Use of Controlled Substancesfor the Treatment of PainThe Model Policy provides that: the prescribing ofcontrolled substances for pain will be considered to be for alegitimate medical purpose if based on sound clinicaljudgment. All such prescribing must be based on cleardocumentation of unrelieved pain. To be within the usualcourse of professional practice, a physician-patientrelationship must exist and the prescribing should be basedon a diagnosis and documentation of unrelieved pain.Compliance with applicable state or federal law is required. </li> <li> 30. Pill Mills Look for documentation in a patients medical record of tes...</li></ul>