A recent federal prosecution in New York serves as a serious reminder that regulators are closely monitoring Schedule II prescribing, even with the telehealth Covid accommodations extended. [The Federal COVID-era telehealth flexibilities permitting doctors to prescribe schedule II controlled substances via telehealth without an in-person evaluation has been extended through December 31, 2026. See here: https://telehealth.hhs.gov/providers/telehealth-policy/prescribing-controlled-substances-via-telehealth.]
Recently, a doctor was sentenced to seven years in federal prison after being convicted of prescribing oxycodone pills without a legitimate medical purpose and fraudulently billing insurance providers for procedures that were never performed. In addition to prison time, the court imposed a $150,000 fine and ordered her to pay even more in restitution.
Here, the doctor allegedly issued oxycodone without seeing patients and refilled prescriptions based merely on payment, and, thereafter, submitted fraudulent claims and charged insurance companies for services never provided - clearly this is an extreme case of professional misconduct. So, if such an aberration of care, why highlight? Well, the public nature of the arrest and promulgating the ramification is often a signal broader enforcement priorities. Regulators very regularly follow with more regular audits and investigations aimed at the general population identifying irregular billing patterns and fraudulent prescriptions.
Best practices when prescribing Schedule IIs, include, but are not limited to, ensuring that each prescription follows an in-person patient evaluation (or telehealth, when permitted), documentation of medical necessity, maintain a clear treatment plan, regularly reassess the patient’s condition and risk factors, checking of the Prescription Monitoring Program, and regular urine testing. Prescriptions generally should not exceed a 30 day supply and consulting with the Prescription Monitoring Program (PMP) Registry to monitor the patient’s use is critical. To further strengthen compliance, enter into a written Controlled Substances Agreement with your patients to outline the treatment goals, patient responsibilities, prescription policies, follow-up visits and privacy issues regarding the Schedule II prescription.
Further, under 21 C.F.R. § 1306.04(a), a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The DEA has made it clear that when it comes to prescribing Schedule IIs, this standard requires meaningful patient evaluation and ongoing clinical oversight.
See: https://www.federalregister.gov/documents/2007/11/19/E7-22558/issuance-of-multiple-prescriptions-for-schedule-ii-controlled-substances
