December 21

ARE PHARMACIES AND DOCTORS THE REAL CAUSE OF OPIOID ABUSE?

As you are aware, right now pharmacies, pharmacists-in-charge, NP’s, PA’s and doctors are being hammered in an effort to fight an “opioid epidemic”.

You may wonder why it seems that all the enforcement efforts are focused on small community pharmacies and individual physicians. How much of an effect can such small businesses have? What about wholesalers?

Click this link for an excellent investigative report by The Washington Post on the truth of the matter. DEA Slowed Enforcement While The Opioid Epidemic Grew Out of Control. Read the highly informative article and make up your own mind what is going on. Yes, this article names names.

Voters want to “drain the swamp”. After you read this article I’m sure you will agree that the swamp in Washington and at state government level is vaster and deeper than you may have imagined.

The DEA is a police force and are good at investigating but don’t know how to treat disease states. Drug abuse should be addressed by a multidisciplinary panel of experts from the fields of medicine, pharmacy, substance abuse, sociology, economics, psychology, and public health. Politicians have no knowledge and it shows.

In another blog I will address evidence based treatment.

December 21

HPRP AND THE HOLIDAYS

It’s that time of year when I warn all healthcare practitioners that should you become involved with an alcohol, marijuana or substance abuse matter (criminal or employment) during the Holidays, call me first before you admit to anything. I can’t think of a single time when confessing to something before you talk to a lawyer ever helped. Do not listen to your well-intentioned but misinformed colleague, who will reflexively urge you to report yourself to HPRP. Your colleague is not an experienced, real-life lawyer—I am.

Nobody has mercy today. You don’t deserve to be destroyed. Don’t jump into a wood chipper. It is not at all unusual for novice drinkers to over celebrate during the Holidays and to become involved with law enforcement. Keep my phone numbers in your cell phone. My office number is (586) 598-4650 and my cell phone is (586) 243-5457. If you’re leaving a message, speak clearly and make sure you leave your phone number with the area code. If you are calling late at night, please make sure it is an emergency.

It is inevitable that some of you will be arrested and you need to restrain your feelings of guilt, remorse and shame. While you may feel really bad in the immediate aftermath of such an adverse encounter, remember that you still have to practice your profession and earn a living every day of the next year and years to come.

Please be sure to telephone me before you make any decisions about how to defend yourself in the criminal proceeding, termination from employment or other adverse reaction or in particular, before you decide to self-report to HPRP.

Most people do not need intensive substance abuse therapy which consumes all of your free time, is enormously expensive, changes your employment and takes your freedom and dignity.

Millions of people have over imbibed on occasion and modified their drinking and other behavior on their own without the restraints of harsh, compulsive therapy regimes.

In short, be kind to yourself and your family and do not let panic and guilt overwhelm your own natural, self-protection instincts. At the very least, schedule a conference with me and we will examine the pros and cons in your particular case.

I want you to keep your freedom and dignity. There are scores of health professionals I have saved and no one knows they were ever in criminal jeopardy. It is our secret that I will take to my grave.

September 16

Extreme OIG Audits Concentrating on Arabic Pharmacies?

Lately many of my clients have been plagued with extremely aggressive, to the point of rude visits by persons called OIG inspectors doing a Medicaid audit. However, these audits are unlike any audit you have ever had before. The OIG inspectors who are not pharmacists and are not educated in pharmacy medicine, science or statistics come into the pharmacy and demand to be admitted to the dispensing area.
In my opinion, they have no authority to enter your pharmacy but in fact, are prohibited by law from doing so. Under Michigan law, only a pharmacy board inspector, the DEA or a police task force concentrating on drug investigations can enter a pharmacy. As many of you know, if you are not a pharmacist but own a pharmacy you are only supposed to be in the area where there are drugs when a licensed pharmacist is with you.
Additionally, the auditors act in a very intimidating manner, often refusing to talk to counsel, including me. They assert that they are entitled to have a drug utilization report (DUR) dating back as far as seven years for all prescriptions including cash, HAP, Blue Cross, etc. However, in my opinion the language and interpretation of the regulations only allow Medicaid auditors to examine records required to be kept by law in the provision of services to Medicaid patients. In other words, they are not entitled to information about HAP, cash, Caremark, etc., its prescription or DUR.
Further, they want to know who your employees are, past and present as well as their telephone numbers and personal data. Along with this they want you to tell them who all of your drug inventory suppliers are. What pharmacist remembers every wholesaler or provider of inventory for a year let alone several? Further, many of the wholesalers you might have dealt with on occasion are now out of business and their records are irretrievable.
What is their game? Very easy. I surmise, to put small pharmacies in Dearborn out of business through intimidation or simply to take money from a pharmacy that it cannot afford.
The legitimate standard for the audit industry is batch sampling with a random selection of prescriptions. What these OIG auditors want to do is unscientific, unfair and discriminatory. They want to just state that for example over seven years a pharmacy may have billed $2,000,000.00 for Medicaid prescriptions. However, with the wholesalers that pharmacy recalls (assuming they cooperate accurately) the audit may total inventory purchases of say $1,200,000.00. So they want the pharmacy to pay 800,000.00! That sounds like simple math but it is not proof of fraudulent billings and is grossly discriminatory and unfair.
On Tuesday, September 13, 2016 I cross examined these auditors under oath and learned much. Asking one auditor under oath how many audits he did, and he said 25. I asked of those 25 how many of the pharmacies were corporations owned by people with Arabic surnames? Answer was all 25. I asked them whether they are auditing CVS, Rite Aid, Walgreen, etc., in the same fashion and they said no. You can guess why they don’t want to screw with the big drug chains right?
Even if you are not Arabic or a hospital pharmacist you should care. We are all brother and sister pharmacists and we must support each other. If you are being plagued by these so-called OIG Medicaid audits please call me and we can discuss what to do about this. In the meantime, I would imagine that affected pharmacies would be marshalling their forces to launch a discrimination lawsuit in addition to other torts and causes of action, I would love to file this lawsuit!
Believe me all of my pharmacists complain that it is extremely hard to make an honest living with the low reimbursements from insurance companies and these hyper aggressive supposed Medicaid audits are taking what little pleasure is left in the profession as well as the dignity and wellbeing of the pharmacist and employees.
I fear for the future because I’m probably one of the last attorneys left that stands up for smaller people and businesses and the large law firms would just as soon play baseball with the State to maintain their comfortable lifestyles.
Best wishes to all.

April 9

Existential Threat to Michigan Pharmacist’s Employment

I have learned through confidential, highly-placed sources that the same regime that recklessly poisoned the Flint water system killing eight people (Legionella) and permanently damaging tens of thousands are about to “fix” pharmacy in Michigan this summer.

If you look back in my blogs and Pencak Reports, I condemned a “pilot project” that Michigan politicians authorized allowing telepharmacy. I was very opposed to the legislation because I knew what the real intent of the pilot project was. The pretext the politicians used was a false claim that there were insufficient pharmacists in Michigan to serve our rural population.Fn2 And the solution was to have patients receive medication dispensed by robots while one pharmacist at a remote location skypes with patients to fulfill the counseling need. As long as the skyping pharmacist has a Michigan license he could be in any country on earth, being paid at the lowest rate.

Of course, the real politicians are only effectuating the plan of their corporate donor that wants to increase its profits by eliminating the cost of employing pharmacists and technicians. The fact that a thousand pharmacists will lose their employment in Michigan alone and that the public is in danger is immaterial. Don’t believe that statement? Good…as a health professional you are scientists and know that the essence of science is to prove or disprove a hypothesis in the real world. There are multiple, recent, reliable political science studies that validate the proposition that state and federal legislators do not take into consideration the needs of citizens but do implement the desires of large corporations or very wealthy individuals.Fn1

Why is it that an Ilitch, David Koch or a Dick DeVos can implement legislation and all of the pharmacists in Michigan cannot? The same reason that babies in Flint continued to receive poisoned water while Gov. Snyder spent our tax dollars to hook up a GM engine plant in Flint with pure water because the Flint water was corroding engines. The people got attention (but not pure water) one year later. An informal opinion from the 39th President of the U.S. Jimmy Carter: “the U.S.…is an oligarchy with unlimited political bribery”. President Carter opined that the U.S. Supreme Court’s decision in Citizen’s United “violates the essence of what made America a great country in its political system”.

We have politicians that believe a state should be run the same way as a corporation rather than as a government. Remember, the whole Flint water outrage started with a plan to save $100 a day. In a corporation human safety always takes a backseat to profit—think of GM faulty ignition switch and every Enbridge pipeline.

Pharmacists and prescription consumers are in danger if telepharmacy supplants brick & mortar neighborhood pharmacies.

Who will save us? A uniquely American trait is a belief that a white knight or Superman will come to right wrongs and save the innocent from the powerful wrongdoers. It is understandable, in that Hollywood actualized the concept. Arguably, the first silent-film era superhero was “Zorro”; a completely fictional superhero that protected Californian peons from the oppressive one percenters—landowners in Spanish California.

Europeans for example don’t believe in superheroes saving them from oppressors because good men and women actually fought the good fight against fascism in the 20th Century (1930’s) and lost in Spain. Fascist dictator Francisco Franco (with aid from Hitler) defeated the people in the Spanish Civil War of which Albert Camus wrote:

“Men of my generation have had Spain in our hearts. It was there that they learned…that one can be right and yet be beaten, that force can vanquish spirit, and that there are times when courage is not rewarded.”

I learned in my own life that if I need something I must obtain it. My philosophy is encapsulated this way…If it is to be, it’s up to me.

I won’t tell you what to do about this impending outrage but I will note the following, Zorro or Ironman is not coming to help. Why spend your hard-earned money on political contributions to any establishment politicians? The politicians receive tens of millions from special interests so why would they care about thousands of dollars?

So, if you don’t want telepharmacy in Michigan, it is up to you.


Fn[1] There is actually an excess of pharmacists for the available jobs in Michigan.

Fn[1] See for example e.g.: Testing Theories of American Politics:  Elites, Interest Groups, and Average Citizens, by Martin Gilens and Benjamin I. Page, Publication: Perspectives on Politics; Rich People Rule! by Larry Bartels, Publication: Washington Post; and Stacked Deck: How the Dominance of Politics by the Affluent and Business Undermines Economic Mobility in America by David Callahan & J. Mijim Cha