Health Care Fraud: A Cautionary Tale of Profit Over Patients or Drug Dealers with online recurring revenue models?

The Alarming Reality of Health Care Fraud and Its Impact on Our Communities

In a recent, unprecedented move, the Justice Department has unveiled the results of the 2024 National Health Care Fraud Enforcement Action, charging 193 defendants, including 76 medical professionals, with various health care fraud schemes amounting to a staggering $2.75 billion in intended losses and $1.6 billion in actual losses. This action underscores a disturbing trend where individuals and corporations prioritize personal gain over patient well-being, jeopardizing the health and safety of countless individuals.

The Extent of the Fraud

The scope of this fraud is vast, involving over $900 million in false claims related to amniotic wound grafts, the unlawful distribution of millions of Adderall pills, and more than $1.1 billion in telemedicine and laboratory fraud. Particularly concerning is the revelation that a digital technology company, Done Global Inc., distributed millions of Adderall pills without proper medical oversight, allowing patients to continue receiving prescriptions without necessary follow-up, even refilling prescriptions to people who had died.

The Human Cost

Behind these numbers lies a more troubling narrative of human suffering. Vulnerable patients, including the elderly and those struggling with addiction, were preyed upon by those entrusted with their care. For example, Done Global Inc.’s policies led to patients receiving stimulants without adequate medical supervision, contributing to addiction and, in some tragic cases, overdose deaths.

The DEA Statement (Drug Enforcement Authority)

The defendants in this case operated Done Global Inc., an online telehealth website that prescribed Adderall and other highly addictive medications to patients who bought a monthly subscription. The defendants allegedly preyed on Americans and put profits over patients by exploiting telemedicine rules that facilitated access to medications during the unprecedented COVID-19 public health emergency, instead of properly addressing medical needs, the defendants allegedly made millions of dollars by pushing addictive medications. In many cases, Done Global prescribed ADHD medications when they were not medically necessary. In 2022 the FDA issued a notice of shortages in prescription stimulants, including Adderall. Any diversion of Adderall and other prescription stimulant pills to persons who have no medical need only exacerbates this shortage and hurts any American with a legitimate medical need for these drugs. The DEA will continue to hold accountable anyone, including company executives, that uses telehealth platforms to put profit above patient safety.” DEA Administrator Anne Milgram

The Need for Accountability and Oversight

The charges announced highlight the critical need for stricter regulations and oversight in the prescription and distribution of controlled substances. It's evident that online prescriptions, especially for controlled substances, should be linked to in-person medical reviews to ensure patient safety. The long lines of patients refilling prescriptions without proper medical evaluation are a testament to a system failing its most vulnerable.

A Call to Action

As a society, we must hold those who exploit the healthcare system accountable. This includes not only prosecuting those who commit fraud but also implementing preventive measures to protect patients. It's imperative that health care providers adhere to the principle of "do no harm" and that regulatory bodies enforce these standards rigorously.

At My SOS Family, we are committed to advocating for stronger safeguards in healthcare to prevent such abuses. We support the integration of thorough in-person medical reviews for online prescriptions of controlled substances, ensuring that every prescription is issued with the patient’s best interest in mind, this way the person who evaluates can also be jointly responsible with distribution of controlled substances (Drug Dealing) or fraud if related to over prescribing non-controlled medical items like wound grafts.

Conclusion

The recent enforcement action by the USA Justice Department is a significant step towards addressing health care fraud. However, it is only the beginning. Continuous vigilance, robust oversight, and a commitment to ethical practices are essential to protect our healthcare system from those who seek to exploit it for personal gain.

This is where AI analytics could help highlight trends, by looking at patterns from manufacturers data i.e. their sales patterns to companies, also centralized prescription data, especially refilling prescription data versus standard base line, which is possible in countries like the UK where there is a nationally managed health service like the NHS.

Let us work together to build a healthcare system that truly prioritizes patient well-being over profit, ensuring a safer, more trustworthy environment for all.

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