The Insider Threat

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In recent years the trusting relationship between dentists and their staff has come under scrutiny. Questions such as ‘how much control should my staff have?’ or ‘can my staff have access to my prescription pad?’ are questions posed in a dental office on a day-to-day basis, or so we hope. With 58% of dentists falling victim to prescription fraud, an issue that seems to be hitting dentists is Identity Theft. Not identity theft in the usual sense, but specifically the misuse of a dentist’s DEA number, forged signatures and stolen prescription pads.

The culprit? The Insider Threat comprised of office staff and fellow dentists. As the opioid epidemic kicks into full gear, dental offices are seeing the highest rate of fraud yet with forged prescriptions, specifically for controlled substances, and unfortunately staff members with access to the dentists’ prescription pads are at fault. However, as you will read in Case 3 which will be posted on Thursday August 25^th, dentists also need to safeguard their prescription pads from other dentists! This is not to say that office staff and peers cannot be trusted or that they’re the sole cause of prescription fraud, not at all. However, how much trust is TOO much without proper protocols in place to ensure checks and balances for every prescription being written?

In 2016 alone, there have been numerous cases where an employee of a dental office has been behind the forged prescriptions and stolen prescription pads, which has ultimately led to dentists hanging the good old closed sign on the front door of the office.  This is the type of financial implications such a crime can impose.

Over the next week, we will be discussing specific cases in which a staff member has taken advantage of their employment to receive or distribute unauthorized prescriptions, as well as useful tools to help combat your potential Insider Threat. Stay tuned!

Case 1 – The Office Manager. Thursday, August 18^th

Case 2 – The Assistants. Tuesday, August 23^rd

Case 3 – The Dentist. Thursday, August 25^th

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.

Opioid Turmoil: Addressing the Link between PDMPs and e-Prescribing

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With a nationwide opioid epidemic upon us, states are starting to insist that prescribers conduct a bit of research before writing prescriptions for addictive medications like pain medications or benzodiazepines. States have therefore created statewide Prescription Drug Monitoring Programs (PDMPs) to monitor an individuals’ controlled substance dispense trends which are meant to assist a prescriber in making smarter treatment decisions. The goal here is to check a patient’s medication history to determine if the patient is doctor shopping or if they may have potential complications with medication(s) they are taking or have taken. Ultimately, PDMPs aid a prescriber in understanding the risks involved in prescribing these powerful medications for their patients.

“Databases known as Prescription Drug Monitoring Programs show doctors all controlled-substance prescriptions patients get and should be linked with the electronic health records (EHRs) that allow doctors to e-Prescribe.” USA Today

In most states, healthcare professionals who prescribe at least one controlled substance are encouraged, not required, to use PDMPs. The USA Today article addresses the fact that only five states promote the use of PDMPs and less than 20% of doctors use the databases when it isn’t required. On the other hand, e-Prescribing of controlled substances has proven to be an effective tool in combating this crisis, yet only three states have mandated the use of e-Prescribing, and one doesn’t enforce its own law.

Click here to learn more about e-Prescribing and how to stay ahead of this opioid crisis

All 50 States (and D.C) have now passed legislation allowing the e-Prescribing of both controlled and non-controlled substances, which is a drastic change from only a few years ago with federal regulations prohibiting the e-Prescribing of controlled substances.

Let’s take a look at the states that have mandated e-Prescribing:

New York: The first state to mandate and enforce its e-Prescribing laws as of March 2016, New York requires prescribers to check their state PDMP database and prescribers who continue to write paper prescriptions are subject to fines, jail time, or both. Since implementing, total numbers of opioid analgesics prescribed fell by 78%.

Minnesota: Technically the first state to deploy mandatory e-Prescribing, they currently do not enforce the use of such technology. The MN Department of Health recently reported that drug overdose deaths jumped 11% between 2014 and 2015 and more than half were related to prescription drugs, specifically opioid pain relievers, rather than illegal street drugs. Minnesota Health Commissioner Dr. Ed Ehlinger said, “The new data show the need for a broader approach to addressing the root causes of drug addiction and overdoses.” Stay tuned.

Maine: Experiencing one of the highest death rates in the country due to opioid overdose, Maine recently mandated e-Prescribing for schedule II controlled substances and will be put into effect come June 2017. Similar to New York, prescribers will face fines, jail time, or both if they choose to utilize paper prescription pads.

New Jersey is also on the horizon to mandate e-Prescribing in due time. As a collective nation, we can no longer sit back and overlook the link between opioid overprescribing and opioid overdose. E-Prescribing and PDMPs should work hand in hand; the benefits are exceedingly visible and with 3-9% of opioid abusers using forged written prescriptions, it’s a commonsense solution. Protect your company, protect your providers, but more importantly, protect your patients. They depend on it.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.

Congress, Dentists, and the Opioid Crisis: Is Good, Good Enough?

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As the opioid epidemic continues and more policies have recently been implemented to curb this crisis, it seems that a crucial piece of the puzzle is missing: mandatory electronic prescribing. Like Devon Herrick mentions in his latest post, e-Prescribing is a commonsense solution for an issue that isn’t slowing down in the United States. Now is the time for Congress to step up and take advantage of solutions that are not only available, but approved and certified by the DEA. It’s clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments and while states have implemented Prescription Drug Monitoring Programs (PDMPs), they’re not mandatory and the ability to further capture data will undoubtedly be a pivotal cornerstone while facing this epidemic and for several reasons. With electronic prescribing:

1. A prescriber can track a patient’s medication history and make smarter treatment decisions, i.e. doctor shopping, recent prescriptions filled, and drug-to-drug and drug-to-allergy interactions.
2. There is no more need for paper prescriptions, therefore no more interpreting messy handwriting, no more altered dispense quantities, and no more stolen prescription pads.
3.  A significant decline will occur relative to the rate of fraud, resale and abuse of opioids because e-Prescribing secures all information exchanges from diversion.

Electronic prescribing has been utilized by doctors for a few years now, but the e-Prescribing of controlled substances is last to hop on the bandwagon. Until recently, federal regulations prohibited e-prescribing of controlled substances due to perceived risks, however electronic prescribing diminishes these elements of risk.

Click here to learn more about e-Prescribing and start saving time and money today!

Since New York mandated that all prescriptions must be sent electronically, dentists in particular, have seen a vast change in the number of opioid prescriptions: “In a study of dentists, within a few months after iSTOP was implemented in New York, opioid prescriptions fell by about half, from 31 percent of dental visits before iSTOP to 14 percent in the following three months. The quantity of pills per prescription also fell. The total numbers of opioid analgesics prescribed fell by three-quarters (78 percent).”

Whether it’s mandated or not, the numbers don’t lie – electronic prescribing proves to be the smarter and safer force as we battle opioid addiction. Congress, take note.

Sources: National Center for Policy Analysis; PLOS; National Safety Council; NPR; Congress

About DoseSpot DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.

How Costly Are Prescription Pain Meds? CVS Can Tell You.

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If only money grew on trees—I’m sure the revolving door of CVS’ bank accounts hope so. In the hot seat once again, the U.S. Attorney’s Office for the District of Massachusetts announced on Thursday, June 30, that CVS is to pay $3.5 Million to resolve allegations that pharmacists have been filling forged prescriptions for controlled substances more than 500 times between 2011 and 2014. They failed to recognize the red flags for fake prescriptions and computer system bans on individuals receiving addictive drugs and did not alert the authorities. Unfortunately, this isn’t the first time CVS has had to shell out a large sum of money as a result of negligence when filling controlled substances.

May 2015 – $22 Million; Florida

August 2015 – $450,000; Rhode Island

February 2016 – $8 Million; Maryland

June 2016 – $3.5 Million; Massachusetts

“DEA registrants like CVS have a corresponding responsibility to dispense controlled substances in accordance with the Controlled Substance Act.  When pharmacies fail to adhere to these responsibilities, it allows for the diversion of prescription pain medication, which contributes to the widespread abuse of opiates, is the gateway to heroin addiction, and is devastating our communities,” said DEA Special Agent in Charge Michael J. Ferguson.  

Furthermore, dentists were victimized once again. A woman identified as “P.R.” signed a dentist’s name on 56 of 59 oxycodone prescriptions that were filled at five CVS locations, even though CVS had banned her back in 2011. Creating a new patient profile with a different last name was her way in. Another forger had used a Massachusetts address for a dentist who had moved to Maine.

Click here to learn more about e-Prescribing and start saving time and money today!

The settlement money is going to the Department of Justice for now, but there are hopes that this money will be used toward prevention—specifically addressing the need for a way forged prescriptions will never even be able to happen. This is where e-prescribing comes into play. e-Prescribing eliminates paper prescriptions, thus eliminating the risk of forged prescriptions, altered quantities, and stolen prescription pads.

Contact us today to learn how seamless the e-Prescribing transition can be with DoseSpot on your side and let’s combat this opioid epidemic together.

Sources: Boston Globe; U.S. Attorney’s Office, RI; U.S. Attorney’s Office, MA; U.S. Attorney’s Office, MD; U.S. Attorney’s Office, FL

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.

The Opioid Epidemic—Are Dentists the Black Sheep?

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Once again, the dental industry is in the hot seat regarding their perceived contribution to the opioid epidemic that the United States is currently facing. As part of their “Hooked” series, NBC News recently reported on this deadly triangle: the relationship between dentists, drugs, and dependence and how dentists are at the forefront of this crisis, even citing that they’re taking the easy way out when treating patients.

“We see it across medical and dental practices that physicians and dentists are giving patients extra medication just in case to avoid seeing the patient again or writing for refills. This is an obvious problem that leaves a lot of left over medication and patients hold on to it.” -Dr. Brian Bateman, Division of Pharmacoepidemiology and Pharmacoenocomics at Brigham and Women’s Hospital.

The article highlights a young woman’s journey from substance abuse to recovery, stating that her addiction to opioids started at her dentist’s office. She was having her wisdom teeth removed, a very common procedure among adolescents that typically warrants pain medication, but she was prescribed a 30-day supply and was not properly educated on the effects an opioid can produce. Having only experienced pain for a few days, she continued to take the medication because it made her feel invincible, powerful even, and the extra pills were just laying around. Unfortunately, this is how opioid addiction usually starts: with a prescription. Patients these days are also going to extreme lengths to obtain these substances such as doctor shopping to receive more medication, buying or selling on the black market, and sharing prescriptions with friends and family.

Click here to learn more about e-Prescribing and start saving time and money today!

Of course this isn’t the first time dentists are being victimized as the gatekeepers for these controlled substances. There has been a dramatic rate of response from organizations across the country in regards to this increasing epidemic. Senator Dick Durbin of IL recently wrote a letter to the American Dental Association (ADA), among other associations, which ultimately bashed the industry and claimed that dentists fail to take responsibility for its role contributing to the crisis and that they’re taking advantage of perceived financial incentives to over-treat pain. Likewise, articles published by JAMA and Harvard have made notion that the dental industry is a crucial piece of this epidemic puzzle.

Let’s play devil’s advocate and take a step back to evaluate what is most likely going on in dental offices. What are the pain points, exactly?

Paper prescriptions are not their friend.

Prescription pads or print-out prescriptions leave an immense amount of risk. Who’s to say a patient won’t alter the pill quantity, claim they lost their prescription, or worse, steal a prescription pad? It’s very easy to swipe a small piece of paper without anyone noticing.

They don’t know the unknown.

If a dentist doesn’t know a patient’s medication history, current medications, allergies, or any history of substance abuse, they cannot make an educated decision when it comes to what they prescribe.

They’re simply trying to do their job.

When a patient goes in for a procedure, a dentist naturally wants to make them as comfortable as possible—before, during, and post-surgery. However, prescribing opioids and at high amounts have become the norm nowadays and other alternatives, such as higher doses of acetaminophen or ibuprofen, aren’t even considered.

Luckily, e-Prescribing can mend all of these pain points, while also creating greater clinical efficiency and relieving a dentist’s anxiety for potential risk. It’s completely acceptable to not know all the answers or available resources that are out there as we combat this opioid crisis, but it’s not okay to turn a blind eye. Bottom line is: education is crucial during a time like this. Don’t remain a victim; take action and spearhead the change.

Sources: NBC News; JAMA; Harvard; Boston Globe

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.

National Safety Month; The Danger of a Prescription

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The National Safety Council, in an effort to create awareness and reduce the leading causes of injury and death, has established June as National Safety Month. When one thinks of safety, perhaps the following comes to mind: wearing a seatbelt, keeping a close watch on little ones, or having emergency numbers on hand at all times. However, many fail to remember the importance of safety for prescribed medications—specifically prescriptions of controlled substances.

In 2012 alone, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. In comparison to ten, even five years ago, this number is dramatically increasing as time goes on and more and more opioid overdoses are being reported on a daily basis. Prince? Elvis? Sigmund Freud? Bueller…? While their stories may have been reported nationwide, people from all over the country and from all different backgrounds are unfortunately experiencing this crisis right in their backyard.

Click here to learn more about e-Prescribing and start saving time and money today!

The dental industry is often victimized as the gate keeper of such prescriptions, but luckily there are efforts in place to monitor how, when, and to whom these controlled substances are prescribed. That is, so long as the dental community, both prescribers and Dental Support Organizations (DSOs), are ready to step up and take action. Fortunately, electronic prescribing (e-Prescribing) has the power to assist in alleviating the opioid epidemic that is upon us, but how exactly?

• e-Prescribing diminishes the possibilities of duplicate or lost prescriptions since the prescription is sent directly to the patient’s pharmacy
• A patient will no longer have a paper prescription where the dispense quantity can be altered
• Prescribers will have access to a patient’s medication history, therefore they can determine if a patient is “doctor shopping” or has a history of substance abuse

Be an innovator and stay ahead of the curve, all while enhancing patient safety and quality of care. A patient’s wellbeing and the ever increasing amount of lost lives depends on it.

Sources: World Health Organization (WHO); American Society of Addiction Medicine (ASAM)

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions since 2009. For more information, please visit http://www.DoseSpot.com.

E-Prescribing 101

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Electronic prescribing is not just the ability to send prescriptions electronically to pharmacies. E-Prescribing can also increase care quality in a number of ways:

• E-prescribing makes sure that the prescriber is providing enough specific information for the pharmacist to fill the prescription, including the name of the drug, the dosage, its physical form, the route, and the physician’s instructions.
• Electronic prescribing software eliminates the time and effort of trying to understand the prescriber’s handwriting, as well as the chance of an error in that translation.
• E-prescribing significantly reduces the chance that the prescriber’s intentions are misinterpreted.
• E-prescribing is often used in conjuction with clinical decision support to ensure that any drug to drug interactions or drug to diagnosis issues are found and reported to the physician before the prescription order is completed.

Electronic prescribing is considered one of the most important areas of Healthcare IT, which is why Medicare created payment incentives for physicians who use a qualified e-prescribing system. In 2009, the incentives are an increase of 2% in revenue for each patient when e-prescribing is used. Due to the 2009 HITECH Act, electronic prescribing is required as part of any EMR (EHR) which qualifies for Medicare reimbursement in 2011.