HHS OIG Flags Continued Beneficiary Risk Around Opioid Use

Continuing with the agency’s ongoing tracking of high-risk opioid utilization amid some of its beneficiaries, the HHS Office of Inspector General released an updated report this week highlighting Medicare Part D opioid use and beneficiary risk for misuse, abuse and overdose. In 2017, CMS identified more than 71,000 beneficiaries at serious risk for opioid misuse or overdose in which those prescribing patterns continued into the following year. Upwards of one-half of beneficiaries deemed as at serious risk in 2017 had received an OUD diagnosis; a quarter of those having received a Part D prescription filled for naloxone. Only 7% of those having received medication-assisted treatment such as buprenorphine, naltrexone or methadone.

Recognizing the ongoing risk associated with such utilization, OIG acknowledges greater opportunities to improve CMS’ epidemic response and recommends continued efforts by the agency to further review beneficiary treatment plans and improve education around medication-assisted treatment and access to opioid overdose reversal medications.

Articles & Resources

HHS Office of Inspector General – Medicare Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose: A Closer Look (Report)

Modern Healthcare – CMS Should Do More for the Thousands at Extreme Risk of Opioid Addiction, OIG Finds

Research Finds Heightened Utilization of Non-Pharmacologic Interventions for Opioid Use Disorder

Research published in Health Affairs on Monday outlined findings from a retrospective analysis of SAMHSA data ranging from 2015 through 2017 related to the use of self-help groups and/or medication-assisted treatment given a diagnosis of an opioid use disorder. In total, approximately 10% leveraged both MAT and self-help groups, 29.2% used MAT-only, 29.8% using self-help groups only, and 30.5% using neither. Ultimately, more than 60% of those included in this analysis opted against evidence-based interventions with products such as buprenorphine, naltrexone and methadone.


Source: Wen, Druss, and Saloner, Health Affairs

Statistically significant variances in healthcare utilization were identified across demographic categories with non-Hispanic whites most likely to utilize both interventions (11.1%). Hispanic/Latino (34.6%) and African American (31.8%) patients were most likely to forego either intervention.

Articles & Resources

Health Affairs – Self-Help Group And Medication Use in Opioid Addiction Treatment: A National Analysis

What We Read Last Week

Several articles were published last week pertaining to the opioid epidemic, covering a variety of different components of the issue. Links to relevant articles are provided below.

Articles & Resources

Washington Post – How the Coronavirus is Creating Other Threats for Addicts

CNN – The Opioid Epidemic Was Already a National Crisis. COVID-19 Could Be Making Things Worse.

Law360 – DC Circ. Upholds FDA Abuse-Deterrent Opioid Denial

Wilmington News Journal – Keeping Our Eyes on the Addiction Crisis

Federal Register Notice (SAMHSA) – Program Evaluation for Prevention Contract (PEPC) – Strategic Prevention Framework for Prescription Drugs (SPF-Rx) Evaluation (OMB No. 0930-0377)

U.S. Attorney for the Western District of Washington – DOJ Settles False Claims Act Allegations with Seattle Physician, His Pain Clinics, and His Drug-Testing Lab

U.S. Attorney for the Eastern District of Wisconsin – Milwaukee Pain Management Clinic and Physician Agree to Pay At Least $1.35 Million to Resolve Allegations They Violated the False Claims Act and Anti-Kickback Statute

U.S. Attorney for the Eastern District of Virginia – Doctor Pleads Guilty to Opioid Conspiracy and Health Care Fraud

U.S. Attorney for the District of Connecticut – Connecticut Substance Abuse Treatment Provider Pays $295K to Settle Improper Billing Allegations

U.S. Attorney for the Northern District of Alabama – Fultondale Doctor Pleads Guilty to Prescribing Controlled Substances and Health Care Fraud; Demopolis Pharmacist Pleads Guilty to Health Care Fraud

U.S. Attorney for the Southern District of West Virginia – Mingo County Pharmacy to Pay Civil Monetary Penalties to Resolve Alleged Violations of the Controlled Substances Act

U.S. Attorney for the Eastern District of Pennsylvania – Physician to Pay $50,000 and Permanently Cease Prescribing Opioids to Resolve Allegations of Improperly Prescribing Oxycodone

This Week’s Calendar

We hope that everyone is remaining safe and healthy during the ongoing coronavirus pandemic.

There are no relevant hearings or markups scheduled at this time. In the instance that there are any changes to the schedule for this week, we will make additional information available.

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