Although DEA has long targeted wholesalers as the "choke-point" for stemming diversion, the Agency has now shifted its focus to downstream physician and pharmacy registrants. Providers who thought they understood DEA risk need to revisit their planning because the enforcement paradigm has changed dramatically.

As a former federal prosecutor for DEA cases beginning in 2008, the Agency's shift has been gradual but remarkable. Back in the days before the Ryan Haight Act, the DEA was dealing with internet-based pharmacies that dispensed huge volumes of controlled substances from second-floor, strip mall locations. Similarly, the opioid epidemic in Florida was particularly rampant, with so-called "pill mills" that attracted patients up and down the I-95 corridor from Kentucky to West Virginia and beyond. That's when Joe Rannazzisi, the DEA's whistleblower from the 60-Minutes television show, launched the "Distributor Initiative" because DEA believed that downstream registrants, like pharmacies and physicians, were too numerous for DEA to effectively regulate.

The Opioid Epidemic Has Resulted in Changes

Times have now changed. The Nation's opioid epidemic has educated all of us about the pitfalls associated with miracle drugs that restore daily function and quality of life to millions of patients but overlap with difficult-to-manage scenarios involving addiction and misuse. In addition, many of the major wholesalers operate under compliance decrees and settlements that require them to police their customers closely. I helped build McKesson's suspicious order monitoring program for independent and chain pharmacies and dispensing practices; these algorithms are incredible. As a result, we see less and less of those DEA cases involving lines around the block, hand-to-hand exchanges in parking lots, and security guards in waiting rooms.

Traditional "Diversion" Cases are More Limited

But DEA is still attempting to recover from the scathing criticism and blame the Agency received as a result of the opioid epidemic. Was some of that blame unjustified? Yes, of course. But some of it wasn't. Either way, the so-called pendulum has now swung dramatically towards stricter enforcement, and registrants better heed this trend because it marks a significant departure from DEA's prior approach. For example, it has always been extremely difficult for law enforcement to pierce the doctor-patient visit and a pharmacy's ability to rely on a physician's order. Historically, this has limited the number of traditional "diversion" cases that can be brought.

Routine Inspections Now Result in Extremely Harsh Penalties

DEA's new approach, however, eliminates the need to prove actual "diversion" or "over-prescribing" to impose sanctions. Specifically, DEA's clever new agenda is to target registrants through routine DEA inspections or administrative warrants for "record-keeping" violations. In years past, such record-keeping violations would be resolved through letters of admonition (LOA) or minor civil and administrative fines. Not anymore. Under DEA's latest regime, alleged record-keeping violations are now the genesis of revocation and suspension proceedings brought by the DEA's Office of Chief Counsel, and business-ending, death penalty fines imposed by U.S. Attorney's Offices around the country. In short, a registrant need not "divert" a single pill to be stripped of his or her DEA registration, and a waterfall of board and licensing proceedings typically follows.

DEA & State Controlled Substance Regulations are Confusing

Finally, one reason that DEA's new agenda is so scary is that DEA regulations are opaque, and DEA agents and diversion investigators each have their own interpretations of what those regulations require. In addition, both the DEA and the State in which a business operates typically regulate controlled substances, with areas of overlap and potentially conflicting regulations. As a result, we have been forced to defend pharmacists and physicians who acted in good faith against false DEA record-keeping allegations. In short, if you have any concerns whatsoever about compliance with complex DEA rules and regulations, you need to get buttoned-up immediately. An ounce of prevention will go a long way here, and we have DEA experts available if you need help. Call now for a completely confidential and attorney-client privileged free consultation.

Frequently Asked Questions

HLA Files Emergency Texas Lawsuit Against Optum PBM Audit Termination

Health Law Alliance announces the filing of an emergency lawsuit in federal court for the Northern District of Texas, Dallas Division, to stop Optum's termination of an independent pharmacy that dispensed medications on telemedicine prescriptions and force Optum to comply with federal and state "prompt payment" laws that prohibit withholding of reimbursement.

Read More >>

Pharmacy Benefit Managers (PBMs) Face Possible FTC Lawsuit

The Federal Trade Commission (FTC) plans to sue the top Pharmacy Benefit Managers (PBMs) for anti-competitive practices, including influencing drug prices and favoring their own networks, which disadvantage independent pharmacies and raise prescription drug costs.

Read More >>

Victories Against Optum Rx: Protecting Pharmacy Clients Nationwide

Health Law Alliance has successfully challenged Optum Rx's termination decisions for numerous pharmacies, ensuring they can continue to operate and serve their communities. These victories highlight the firm's expertise in healthcare law and its dedication to protecting pharmacy clients from unjust PBM actions.

Read More >>

FTC Issues Interim Report Condemning Anticompetitive PBM Practices

The top Pharmacy Benefit Managers (PBMs) are condemned by the FTC for manipulating the healthcare system to generate significant profits, thereby inflating drug costs and overcharging patients, particularly for critical medications like cancer drugs.

Read More >>