Question

On May 8, 2014, Ashot Sanamian was indicted on charges of conspiracy to distribute and divert oxycodone, a schedule II narcotic drug, and conspiracy to commit healthcare fraud. Investigators believe that Sanamian participated in a multi-million dollar pill mill scheme that involved diverting over one million OxyContin pills to the streets. According to the indictment, Sanamian was the owner and CEO of A & A Billing Services (A&A) and also participated in this scheme as a "runner." Sanamian's co-conspirators operated a medical clinic in Los Angeles, California, which functioned as a "prescription mill." The clinic generated OxyContin prescriptions for patients who did not need the medication. The prescriptions were then given to runners, including Sanamian and other co-conspirators employed by the Clinic, who either took the recruited patients and/or the prescriptions and related documentation to cooperating pharmacies, which filled the prescriptions. Depending on the insurance plan, the runners then took the OxyContin and delivered it to the clinic administrator, who sold it on the streets. During the Clinic's operation, more than 13,000 bottles of OxyContin were diverted to the streets. Because the Clinic almost exclusively prescribed 90 quantity pill bottles, more than 1.1 million OxyContin pills were diverted during the course of the conspiracy. Medicare paid approximately $2.7 million for OxyContin prescribed by the Clinic and its doctors. Sanamian is believed to have departed the United States. He remains a fugitive at-large.

1. What was significant about the fraud and abuse issue(s) you learned about?
2. What attempts were made, or could be made, to stop the fraud or abuse?
3. What was the role of the Office of the Inspector General in addressing fraud or abuse in the case(s) you watched?

Answer 1

According to the given scenario

part 1

he drug oxycodone is schedule 2 narcotics drug. Which has potential to be used for addiction purpose. It has been proved that Sanamian participated in a multi dollars pill mill scheme that involved in diverting over one million pill to the streets .He was the CEO of A&A billing service and also participated in this scheme as runner.

It is also proved that sanamian co-workers operated a medical clinic in Los Angeles. California, which functioned as a 'prescription mill' . And medication issued by that store was not given to actual person who need . Which clearly indicates it is being used as substance abuse.

There was so many discrepancy maintained in drug distribution suggestive of fraud.

Part 2. Attempt made to stop the fraud and abuse

Government should keep a check on pill mill about the owner and distribution unit.

Schedule 2 drugs especially narcotics should be dispensed on the selected store and with valid license.

There should be proper record from production of such pill to retail store where it is sold.

Medicare should also maintain record of selling of pill and investigate into the matter when there is any abnormalities found.

Part 3 Office of the Inspector General play a pivotal role in investigation of the matter . By providing key proof in revealing the true identity of ashot sanamian. Investigating the matter into ground level and exposing the scam is not a easy task. They did a marvelous job by finding out of every single detail of this case starting from production of drug to selling of drug.