Red Flags That Can Trigger DEA Investigations (Raids) on Your Healthcare Practice
Healthcare practices are subject to a laundry list of regulations at the local, state, and federal levels. Any misstep can lead to oversight and investigations by an alphabet soup of regulatory agencies. Regulatory and legal compliance is key to maintaining best practices and avoiding the unnecessary stress, money, effort, reputational damage, and potential liability that can result from an agency investigation.
If you identify any red flags in your healthcare business that may trigger an investigation from the Drug Enforcement Agency (DEA), it’s important to consult with your healthcare compliance attorney and react quickly to protect your practice. For a discussion of the red flags the DEA watches out for, read on. Call a seasoned California healthcare DEA investigation defense lawyer for help preparing for and responding to government investigations.
What Does the DEA Look for to Trigger an Investigation?
Any number of factors can pique the DEA’s interest in a particular medical practice. There are several specific red flags, however, that are likely to trigger DEA action. The DEA will look for any indication that a medical practice is distributing narcotics outside of the normal channels. Red flags that are likely to lead to a raid include, but are not limited to:
- Maintaining a cash-only practice
- Not billing insurance
- Seeing a large portion of out-of-state patients or patients otherwise traveling long distances
- Purchasing and distributing higher-than-reasonable amounts of opioids such as oxycodone and hydrocodone
- Distributing drugs based on inadequate prescriptions
- Prescribing or distributing unusually high doses of opioids and other drugs
- Prescribing or distributing unusual or unsafe combinations of drugs
- Price gouging for controlled prescriptions
- Providers that are not board certified or not certified in the relevant specialty
- The office is open during abnormal hours
- The office maintains an unusually low number of support staff, such as nurses and medical assistants
- The office does not look like a normal medical office
All of these red flags are possible indicators that a medical office may be prescribing drugs “without a legitimate medical purpose.” If your medical office presents any of these red flags or others, you could soon be facing a DEA investigation. The DEA might send in undercover patients to survey your practice and attempt to obtain under-the-table narcotics, or they may gear up and execute a raid. Consult with your healthcare compliance and regulatory defense attorney to remedy any of these red flags and to prepare your practice for a possible DEA investigation.
Recent DEA Action Illustrates Red Flags
The DEA recently revoked the DEA registration of a pharmacy located in Cape Coral, Florida, after determining that the pharmacy repeatedly filled prescriptions despite obvious red flags indicating the prescriptions they were receiving were not legitimate. The government identified several red flags the pharmacy failed to notice or appropriately respond to, including price gouging, “cocktail medications” of poor combinations of prescriptions, improper dosing for pain management, long distances traveled by patients, and cash payments. Each of these factors should have indicated the prescriptions were not legitimate; taken together they were enough for the DEA to determine the pharmacy did not fulfill its responsibility to follow federal and state law.
Call a Trusted Healthcare Law and Regulatory Compliance Attorney for Help Anticipating and Responding to Agency Investigations
For help responding to billing fraud or regulatory compliance issues, assistance with building your medical practice, or advice and representation concerning internal investigations, auditing, employment matters, governance issues, business disputes, licensing, or any other California healthcare law matter, contact the Law Offices of Art Kalantar in Los Angeles or California statewide at 310-773-0001.