Medicare Compliance & Reimbursement

From prescribing to prevention, the feds have a site for it.

If you look closely, you can see a common thread that binds many of the high-profile Medicare fraud and abuse cases. From large-scale takedowns to small town fraudsters, the opioid epidemic continues to impact patients and providers everywhere.

History: According to the Centers for Disease Control (CDC), the opioid epidemic hit the United States in three distinct waves starting in 1999, with more than 630,000 deaths since then attributed to the drugs. The first wave rose from "increased prescribing in the 1990s" while the next ripple saw a rise in heroin-induced deaths, says CDC online guidance. The current wave, which began in 2013, brought increased usage, overdose, and deaths from synthetic opioids, the CDC notes.

All of these major issues contributed to significant daily deaths from opioid abuse estimated at around 115 deaths a day, suggests updated CDC materials. For these reasons and the toll the crisis is taking on the nation, President Trump declared the opioid epidemic a Public Health Emergency (PHE) last October, "mobilizing his entire administration to address drug addiction and opioid abuse," a White House Press Secretary release stated.

With the PHE underway, enforcement agencies have increased their efforts to rein in medical personnel adding to the opioid death knell, particularly those who've abused the Medicare system for profit at the expense of beneficiaries. However as the pressure mounts, so do the regulations and requirements with many honest providers confused about what is legal.

Pocket this go-to list of the five best online resources for providers that offer insight and education on the opioid epidemic and how to combat it.

1. HHS.GOV/OPIOIDS. The HHS site offers a plethora of federal tools designed to assist practitioners in the midst of the crisis. A few of the options include: disposal of opioids, safe prescribing advice, awareness and prevention campaign resources, and more. To access the HHS website, visit www.hhs.gov/opioids/prevention/index.html.

2. CDC Opioid Overdose. The CDC's offering looks at the epidemic from a different angle with a history of the problems, abuse, and overdose statistics, and how to deal with the current situation. The provider section is a virtual cache of tools from clinical advice to mobile apps to training. You can find the CDC information at www.cdc.gov/drugoverdose/index.html.

3. Medicare Part D Opioid Prescribing Mapping Tool. This interactive website presents clinicians and their staffs with options to see "geographic comparisons, at the state, county, and ZIP code levels, of de-identified Medicare Part D opioid prescription claims - prescriptions written and then submitted to be filled - within the United States," says CMS. The localized information gives Medicare providers a window into their communities' issues with opioidaddiction - and how to address the problem. To see your town's data, visit: www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/OpioidMap.html.

4. Opioid Epidemic and Health IT. E-Prescribing tools abound in the Office of the National Coordinator for Health Information Technology (ONC) Health IT Playbook under the section titled "Opioid Epidemic and Health IT." The online source advises clinicians on the Prescription Drug Monitoring Program (PDMP) and other regulations specifically related to health IT and opioids. For a closer look, visit www.healthit.gov/playbook/opioid-epidemic-and-health-it/.

5. Risk Evaluation and Mitigation Strategy (REMS) for Opioid Analgesics. The U.S. Food & Drug Administration (FDA) approaches the opioid epidemic from a different angle with data and alternatives on pain management, monitoring, drug options, and opioid facts and breakdowns. Access the FDA's opioid tools at www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm163647.htm.