Dedicated to helping health professionals.

Top 10 Tips for Physicians To Avoid Prosecution for Over Prescribing

By Ronald W. Chapman, II

With increased regulation in the health care industry, physicians, now more than ever, are being indicted or charged for over prescribing narcotics or drug trafficking. Here are 10 tips to avoid criminal charges if you are a physician authorized to prescribe controlled substances.

1. Keep Accurate and Detailed Documentation
As a physician, detailed record keeping is a must. Too often my clients keep sparse progress notes and fail to document every aspect of the patient interaction. In the event of an inspection or audit, your records are a lifeline and will help your attorney defend your treatment of patients.

2. Ensure Medical Necessity Prior to Prescribing Controlled Substances
Medical necessity is established by physical exams, review of patient history, supporting medical records, vital signs, and additional tests (Blood, MRI, EMG etc.). Make sure you fully establish the medical necessity for prescribing narcotics prior to writing that prescription.

3. Consider Non-Opiate Alternatives
Consider the effective use of NSAIDS and other medications before prescribing controlled substances and fully document why they should not be considered or will not be effective.

4. Use A Pain Management Contract
Pain management contracts are a vital tool for establishing informed consent and establishing rules that the patient must adhere to in order to be fully compliant with a treatment plan. Consider random urinalysis testing, pill counts, and compliance with a physical therapy plan etc.

5. Fully Enforce Pain Management Contract Violations
One of the worst things a doctor can do is establish a pain management contract and then willingly allow violations of its terms. If a patient tests negative for the controlled substances you prescribe or is found to be “doctor shopping” you must enforce your contract and consider referral to an addiction medicine specialist or some other plan of action.

6. Conduct Regular Audits of Your Own Prescribing And Patients
Clients often have me routinely audit their practice to ensure compliance with DEA rules and State rules for prescribing. A proper compliance plan can keep you out of hot water.

7. Monitor Your Office Staff for Potential Diversion
We don’t want to believe this is true but a large number of allegations against doctors stem from office staff running amok. Nurses, medical assistants, and office staff have been known to steal prescription pads, call in their own prescriptions and otherwise divert medication. Monitor this and make sure this is not happening to you.

8. Make Sure Your Prescriptions Are Being Filled At A Specific Pharmacy Selected By The Patient
The DEA can easily find out when patients are traveling long distances to fill prescriptions and see this as a “red flag” for diversion. You should only treat local patients and ensure that they fill their prescriptions at a local pharmacy.

9. Fully Document the Medical Necessity for Prescribing Multiple Controlled Substances and for Increased Dosage
We live in a statistical world and the DEA largely uses statistics to begin an investigation against doctors. If your controlled substance numbers are higher than your peers you will need a well-documented justification in each medical record.

10. Don’t Take On Too Much
Too many patients, or too many complicated cases could lead you to cut corners in your treatment of your patients. This will cause you to inadequately treat your patients and inadequately document your treatment.