Major Medical Fraud Investigation Involves Opioid Prescribing, Includes Doctors, Facilities, Genetic Testing Lab
The Department of Justice announced this week that more than 400 persons were to be charged as a result of a massive crackdown on medical fraud involving prescription opioids. The investigation focused on physicians suspected of the unneeded prescribing of opioids, as well as health care facilities who exploited addicts.
Over $1 billion was fraudulently billed, most of which was paid by the government through the illicit billing of Medicare and Medicaid. Among the accused include a doctor from Houston who allegedly sold thousands of opioid painkillers for cash, and a false rehab center in Florida who reported used gift cards and trips to casinos to lure clients to their facility.
In connection with the medical fraud, Attorney General Sessions stated that close to 300 health care providers were being banned or suspended from federal health care programs participation:
“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients. Amazingly, some have made their practices into multi-million dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed.”
As additional information has come to light, even more defendants have been uncovered, including three persons associated with Physicians Primary Care of Jeffersonville, Indiana, who reportedly unnecessarily dispensed oxycodone and hydrocodone to patients.
The individuals in question, Jeffrey Campbell, M.D., and nurse practitioners Mark Dyer and Dawn Antle are accused of causing Proove Bioscience, Inc. to fraudulently bill multiple health care programs for genetic testing received by patients treated in their practice that was not for medically legitimate purposes.
Proove Bioscience, Inc. is a genetic testing company located in Irvine, California. Proove is a controversial company that is now apparently linked to medical fraud. However, at the time of this writing they are not officially charged in the indictment, assuming no intentional wrongdoing on the part of the company.
In February, STAT News reported that the Inspector General for the Department of Health and Human Services, in addition to the FBI, were investigating Proove for potential criminal activity. Past and present employees of the company were interviewed by the FBI and stated that the agents were concentrating on illegal kickbacks to physicians who urged patients to undergo Proove’s DNA testing.
Last month, STAT news reported on Proove again. They said that investigators searched a DNA testing lab and confiscated boxes of documents. They also said that shortly after their February report, Proove lost many large accounts with physicians who ordered tests, and much of the company’s staff was let go.
Doctors were reported to have earned up to $144,000 per year in research fees from Proove, who paid out $30 per test.
Proove issued this statement in June:
“Proove has been subject to a handful of inaccurate stories. We can no longer ignore these false stories based on unreliable sources, and filled with erroneous accusations… spread by a few disgruntled former employees and consultants.”
Research at Proove Biosciences
Proove Biosciences purports to be a “leader in personalized pain medicine” and states that genetic testing they have undergone has been proven effective in clinical research at discovering medicines that are best for treating pain and other health issues. Their website states:
“Proove’s predictive analytics platform improves health care decisions, and we deliver that information through precision medicine profiles. Proove helps clinicians, patients, and payers overcome the burden of pain.”
Last month, the company stated in a press release than 91% of patients in a peer-reviewed study said they experienced pain relief following changes in treatment suggested by its genetic testing. The study, which was led by Katrina Lewis, M.D., was said to be accepted by the Journal of Addiction Research & Therapy for publication.
Unfortunately, at the time of this writing, the research has not yet been published. In fact, the journal’s publisher has been accused by the Federal Trade Commission of deception regarding the true nature of its peer review process.
According to the complaint filed last year, OMICS International has manifested hundreds of open access medical journals that have not thoroughly undergone the peer review process. Also, study authors are charged large fees to have their articles published.
OMICS did publish a study in March by Proove in the Journal of Addiction Research & Therapy that claimed that one of the company’s genetic tests could pinpoint patients at a heightened risk of developing an opioid use disorder, and Proove noted in a press release that the research had undergone the peer-review process.
Another study by Proove was published in the online journal Pharmacogenomics and Personalized Medicine by Dove Medical Press, a similar, suspicious publisher that charges exorbitant fees to authors to have their studies included in medical journals.
~ G. Nathalee Serrels, M.A., Psychology