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Seven insider tips to reduce legal risks of opioid prescribing

Note: This article appeared in Medical Practice Compliance Alert, a sister publication of Part B News.
Medical Practice Compliance Alert has previously outlined several steps physicians should take to protect themselves when they prescribe opioids, such as following Centers for Disease Control and Prevention and state clinical guidelines, complying with state laws that limit opioid prescribing, prescribing opioids only when medically necessary and avoiding relationships with pharmacies that may violate the anti-kickback law (MPCA 10/17).
Now that the Department of Justice has ramped up its efforts to fight the opioid epidemic further, physicians should expect even more scrutiny of their opioid prescribing patterns (MPCA 4/18). Here are seven steps that insiders shared during the American Bar Association Health Law Section’s annual emerging issues in health care law conference in February that practices should take to reduce their legal risks:
  1. Have a policy on opioid prescribing and implement it consistently. “When you’re audited, you’ll need to show you’re following your own guidelines,” says attorney/pharmacist Erica Lindsay, Lindsay Law, Chicago. If you deviate, document why, Lindsay says.
  2. Educate patients about opioids and any limits you impose. “Doctors were focused on getting the pain to zero. But we’re going through a huge overhaul of what’s expected for pain. Patients will accept it,” says Lindsay.
  3. Consider co-prescribing the opioid antidote naloxone when prescribing opioids. That way, it is available for use if the patient suffers an overdose, says Christopher Luke Peterson, D.O., family medicine physician and addiction medicine specialist in Phoenix.  
  4. Refine your prescription habits. If clinically feasible, put the patient on a long acting opioid, which has a different, less addictive effect on the brain. If a new patient who is already on a high opioid dosage comes in, don’t automatically write a prescription for the same amount, says Lindsay.
  5. Follow the unique documentation obligations for treating high-dose patients, says Lindsay. For example, note that you checked the state prescription drug monitoring program data base in states that require or encourage it, that the patient was provided a treatment plan and the status of any tapering off. 
  6. Have a method to say no to the patient. If you suspect a patient of doctor shopping or other wrongful activity, you may need to stand up to the patient, says Lindsay. That’s not always easy, especially for a patient who claims she’s in pain. “You may need to protect them. Dr. Murray couldn’t say no to [his patient] Michael Jackson [and look what happened],” she points out. You might need to give an excuse, such as needing to order new prescription pads.
  7. Don’t assume that an opioid manufacturer marketing its product is providing truthful information. You don’t want to rely on assurances that turn out to be inaccurate or false. One of the biggest allegations against manufacturers by both the DOJ and the hundreds of lawsuits filed by states and municipalities is that the manufacturers deceived physicians, misrepresenting the risk of long-term use and recommending off-label uses in violation of Food and Drug Administration rules.
Training opportunity: Get a full hour of expert guidance on opioid compliance, and answers to your question about how to protect your practice from this growing compliance risk. Register for today for Opioid Management Challenges for the Pain and Non-Pain Practice, Wednesday, May 9, 12:30-1:30 a.m., ET. For more information or to register by phone: 1-855-CALL-DH1.
Remember, the cost of one webinar registration covers your entire staff. They can listen live via speaker phone, plus they’ll have access to an on-demand recording after the webinar.
Blog Tags: compliance
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