An average of 130 deaths each day from opioid abuse. An economic cost of $1 trillion over the past two decades. A decrease in American life expectancy for the first time in a hundred years. The stats testify to a health and public safety epidemic without an easy solution. As the dependencies grow, there is, unfortunately, no shortage of bad actors willing to exploit the demand for personal gain.
Health care providers and pharmacists stand at the forefront of preventing these types of abuses. The vast majority are conscientious and dedicated to controlling opioid abuse. The few who are not, however, can have an outsized impact on public safety. States are cracking down on the pill mills that feature unscrupulous doctors or nurse practitioners writing prescriptions for opioids, ostensibly for pain relief, with minimal or no interaction with the patients they serve. But opportunities for wrongdoing are everywhere. Writing fraudulent prescriptions is one way to tap into the supply chain, another is to be a pharmacy illegally distributing the drugs. With the stakes so high, for every scheme thwarted, several more emerge.
Exploring an Untapped Investigative Layer
Currently, agencies have a range of resources for investigating opioid fraud. The Prescription Drug Monitoring Program (PDMP) tracks prescriptions provided by pharmacies or doctors in a centralized database. Other integral tools include street-level policing and undercover tactics, financial record searches, insurance claim data, and reporting systems that track drugs from their point of manufacture to point of sale.
As valuable as these resources are, there’s a missing investigative dimension that these tools cannot reach. Behind each of the participants in a transaction, whether a ‘patient’, a prescriber or a pharmacist, are billions of real-time data points that tell a unique story. These are the relationships, behaviors, actions and intent etched in publicly available online data, that, when distilled, serve as a potential compass in fraud investigations. With advanced technology that allows analysts to gather and analyze this information, and conduct a multi-dimensional investigation empowered by automated insights, it is possible to discover an illicit connection between a ‘patient’ and the doctor fraudulently prescribing OxyContin. Or whether the man who travels to a pharmacy 100 miles away for Percocet is a childhood friend of the pharmacist. By cross-referencing this data with other resources, a previously hidden picture of suspicious activity appears.
The Bullhead City Opioid Ring
In November 2017, police arrested a woman working as a medical billing assistant at a doctor’s office in Bullhead City, Arizona. According to the attorney general’s office, she used her position to create fictitious patient profiles and forge illegal prescriptions for oxycodone tablets. Members of her opioid ring were given these fraudulent prescriptions on the condition that they return some of the tablets once the prescriptions were filled.
By using publicly available online data, the following information about her case comes to light:
- The nature of the relationship between the ringleader and her co-conspirators, who acquired narcotics by fraud and forgery
- Individuals who were not implicated but are closely connected to multiple members of the ring; these people are typically of interest in an investigation
- Inappropriate relationships between those in a position to provide prescriptions and those receiving them
This is not information that can be acquired through the usual investigative resources. But by using advanced techniques, a far more detailed picture quickly takes shape.
Pulling the Threads Together
The war against opioids is waged on many fronts. Ensuring that controlled drugs are acquired solely by legitimate means is a vital public safety issue and an essential means of stopping its spread. The existing fraud detection safeguards are of extreme importance, but used in isolation, they cannot deliver a complete solution. To learn more about how Voyager Labs can help, click here.
