Testimony Before the United States Senate Committee on Finance 
 
 
 
 
OIGs Efforts to Address the Prescribing and  
Treatment Dimensions of the Opioid Crisis  
 
Testimony of: 
Gary Cantrell 
Deputy Inspector General for Investigations 
Office of Investigations 
Office of Inspector General  
Department of Health and Human Services 
 
 
 
 
October 24, 2019 
9:00 a.m. 
Dirksen Senate Office Building, Room 215       
 
 
Testimony of: Gary Cantrell 
Deputy Inspector General for Investigations 
   Office of Inspector General, U.S. Department of Health and Human Services 
 
Good morning, Chairman Grassley, Ranking Member Wyden, and distinguished members of 
the Committee.  I am Gary Cantrell, Deputy Inspector General for Investigations with the 
Department of Health and Human Services (HHS) Office of Inspector General (OIG).  
 
I appreciate the opportunity to appear before you to discuss OIGs enforcement efforts and 
other work to address the prescribing and treatment dimensions of the opioid crisis.  
 
OIG is charged with overseeing all HHS programs and operations.  We combat fraud, waste, 
and abuse in those programs; promote their efficiency, economy, and effectiveness; and 
protect the beneficiaries they serve.  To accomplish this, OIG employs tools such as data 
analysis, audits, evaluations, and investigations.  We are a multidisciplinary organization 
comprising investigators, auditors, evaluators, analysts, clinicians, and attorneys.  We 
depend on our strong public and private partnerships to ensure coordinated enforcement 
success. 
The Office of Investigations is the component of OIG that investigates fraud and abuse 
involving HHS programs.  Our special agents have full law enforcement authority and effect 
a broad range of actions, including the execution of search warrants and arrests.  We use 
traditional as well as state-of-the art investigative techniques and innovative data analysis to 
fulfill our mission.  Our office has investigators covering every State, the District of 
Columbia, Puerto Rico, and other U.S. territories.  We collaborate with other Federal, State, 
Tribal, and local law enforcement authorities to maximize our impact. 
INTRODUCTION 
OIG has, for several years, identified curbing the opioid crisis as one of the Departments 
Top Management and Performance Challenges, as well as one of OIGs four priority focus 
areas.1  Key components of that challenge include addressing inappropriate prescribing of 
opioids, improving access to treatment, and stopping the misuse of grant funds.  In addition, 
combating fraud issues, such as drug diversion and billing for medically unnecessary 
prescriptions or services not actually rendered by providers, presents a significant challenge 
                                                           
1 The other three priority areas are: (1) promoting patient safety and accuracy of payments for services 
furnished in home and community settings, (2) strengthening Medicaid protections against fraud and abuse, and 
(3) ensuring health and safety of children served by grant-funded programs.  For each priority focus area, OIG 
executives and senior-level staff develop strategies, drive action, unleash organizational creativity, and measure 
impact to provide solutions and improve outcomes for HHS programs and beneficiaries.  OIGs current priority 
focus areas were selected based on past and ongoing work, top challenges facing HHS as identified annually by 
OIG, ability to collect data, and ability to influence outcomes. 
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for the Department.  OIGs ongoing opioids-related work is taking a multifaceted approach, 
looking at a variety of issues on both the prescribing and treatment dimensions of the crisis.  
 
OIG has a longstanding and extensive history of enforcement and oversight work focused on 
prescription drug fraud, drug diversion, pill mills, medical identity theft, and other schemes 
that harm patients and waste taxpayer money.  For years, OIG has been acting to address a 
rise in fraud schemes involving opioids, as well as associated potentiator and treatment drugs 
and ancillary services.  In addition to increasing our investigative efforts to combat 
prescription drug abuse, we have responded to the growing severity of the opioid crisis by 
focusing on work that identifies opportunities to strengthen program integrity and protect at-
risk beneficiaries.  OIG uses advanced data analytics tools to put timely, actionable data 
about prescribing, billing, and utilization trends and patterns in the hands of investigators, 
auditors, evaluators, and government partners.  Our goal is to identify opportunities to 
improve HHS prescription drug programs to reduce opioid addiction, share data and educate 
the public, and identify and hold accountable perpetrators of opioid-related fraud.  
 
Today, I will highlight how OIG addresses both the prescribing and treatment dimensions of 
the opioid crisis through expanding law enforcement activities, led by my Office of 
Investigations, as well as new OIG work such as audits, evaluations, and data briefs, to 
combat opioid-related fraud, waste, and abuse while ensuring that both substance use 
disorder treatment and beneficiary continuity-of-care needs are met.  
 
OIGS EFFORTS TO ADDRESS THE OPIOID CRISIS ARE INCREASING 
THROUGH EXPANDING LAW ENFORCEMENT PARTNERSHIPS  
Over the past 2 years, through expansion of Medicare Fraud Strike Force districts, 
establishment of the Opioid Fraud and Abuse Detection Unit Initiative, and establishment of 
the Appalachian Regional Prescription Opioid (ARPO) Strike Force, OIGs enforcement 
efforts to address the opioid crisis have increased significantly.  For example, we have seen 
an increase of more than 100% in open opioid-related cases from 2015 to 2019.  
 
Medicare Fraud Strike Force  
The Strike Force effort began in Miami, Florida, in March 2007 and has expanded to now 
include a total of 12 districts.  Strike Force teams effectively harness the efforts of OIG and 
the Department of Justice (DOJ), including Main Justice, U.S. Attorneys Offices, the 
Federal Bureau of Investigation (FBI), and the Drug Enforcement Administration (DEA), as 
well as State and local law enforcement, to fight healthcare fraud in geographic hot spots.  
 
Strike Force partnerships between HHS-OIG, DOJ, U.S. Attorneys Offices, the FBI, and the 
DEA are a force multiplier that utilize data proactively to identify high-risk districts to target 
the worst offenders involved in criminal conduct or fraud associated with the improper 
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prescription, distribution, possession, and use of opioids.  This coordinated and data-driven 
approach to identifying, investigating, and prosecuting fraud has produced record-breaking 
results, including the June 2018 National Health Care Fraud Takedown, the 2019 
Appalachian Regional Prescription Opioid Strike Force Takedowns, and most recently, the 
2019 Regional Health Care Fraud and Genetic Testing Takedowns.  
 
Appalachian Regional Prescription Opioid Strike Force 
In October 2018, DOJ, in partnership with HHS-OIG, FBI and DEA, launched the ARPO 
Strike Force.  The mission of the ARPO Strike Force is to identify and investigate healthcare 
fraud schemes in the Appalachian region and surrounding areas, and to effectively and 
efficiently prosecute medical professionals and others involved in the illegal prescription and 
distribution of opioids.  This new Strike Force is operating out of two hubs based in the 
Cincinnati-Northern Kentucky and Nashville, Tennessee, areas, and supports the 6 States 
and 10 districts that make up the ARPO Strike Force region: Eastern, Middle, and Western 
Districts of Tennessee; Northern District of Alabama; Eastern and Western Districts of 
Kentucky; Northern and Southern Districts of West Virginia; Southern District of Ohio; and 
most recently, Western District of Virginia.  The ARPO Strike Force has spearheaded 
takedowns in April and September 2019, resulting in charges against 73 individuals, 
including 64 medical professionals.  
 
Collaboration With Public Health Partners 
As part of the ARPO takedowns, OIG and our law enforcement partners worked in close 
collaboration with HHSs Office of the Assistant Secretary for Health (OASH), the Centers 
for Disease Control and Prevention (CDC), the Commissioned Corps of the U.S. Public 
Health Service, and the States respective Departments of Health to deploy Federal and 
State-level strategies and resources to provide assistance to patients impacted by the law 
enforcement operations with additional information regarding available treatment programs 
and where they can turn for quality assistance.  I will further discuss this new effort to ensure 
continuity of care and prevent patient harm later in my testimony.  
 
In addition, OIG also implemented a pilot program providing OIG special agents in the 
ARPO region with a nasal spray version of naloxonea drug that reverses the effects of an 
opioid overdose.  The special agents were equipped and trained to treat any law enforcement 
officer who came into accidental contact with an opioid or any individual in medical distress 
caused by an opioid overdose encountered as part of the operations.  OIG has expanded this 
program nation-wide to ensure that we are prepared to address agent and public needs that 
could arise as we engage in enforcement efforts.   
 
Healthcare Fraud Takedowns  
Over the month of September, along with our Medicare Fraud Strike Force, several U.S. 
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Attorneys Offices, and various other Federal, State, and local law enforcement agencies, 
OIG participated in a series of  healthcare fraud takedowns across the country.  In total, these 
coordinated law enforcement activities resulted in charges against over 380 individuals, 
including 178 medical professionals and 105 defendants for opioid-related offenses, who 
allegedly billed Federal health care programs for more than $3 billion and allegedly 
prescribed or dispensed approximately 50 million controlled substance pills. 
 
Overall, the 2018 National and 2019 Regional and Appalachian Regional takedown efforts 
demonstrate OIGs commitment to rooting out fraud in HHSs opioid prescribing and 
treatment programs, helping to protect patients from harmful prescribing and worthless 
treatment services.  
 
OIGS OPIOID FRAUD ENFORCEMENT EFFORTS  
Opioid fraud encompasses a broad range of criminal activity from prescription drug 
diversion to addiction treatment schemes.  Many of these schemes are elaborate, involving 
multiple co-conspirators including healthcare professionals such as physicians, nonphysician 
providers, and pharmacists, and sometimes even beneficiaries or patients themselves.  These 
investigations can be complex and often involve the use of informants, undercover 
operations, and surveillance.  
 
Of particular concern is fraud involving medication-assisted treatment (MAT), sober homes, 
and ancillary services such as drug screening and urinalysis.  Through our oversight of 
opioid treatment facilities, we have seen a recent increase in MAT-related prescription fraud 
cases, particularly those involving buprenorphine. 
 
Case Examples  
The following examples highlight common schemes involving prescription and treatment 
opioid-related fraud:  
 
Prescription Fraud 
In Maryland, OIG recently worked a joint case with Federal, State, and several local 
law enforcement agencies to investigate allegations that Starlife Wellness Center was 
operating as a pill mill, charging patients $400 or more in cash for each office visit in 
exchange for unlawful prescriptions for large quantities of narcotics.  Patient deaths 
were attributed to the prescribing practices of Dr. Kofi Shaw-Taylor and Starlife 
owner/general manager Tormarco Harris.  Ultimately, Dr. Shaw-Taylor and eight co-
conspirators were all indicted and charged with a variety of crimes, pled guilty, and 
sentenced to prison.  Harris was found guilty at trial and sentenced to 20 years 
incarceration without the possibility of parole, 5 years probation, and a $10,000 fine. 
   
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Treatment-Related Fraud 
Dr. Rajaa Nebbari and Dr. Chethan Byadgi, owners/operators of a medical practice in 
Pennsylvania that operated as an urgent-care medical clinic and a Suboxone 
treatment facility, both pled guilty to one count each of Medicaid Fraud, Theft by 
Deception and Insurance Fraud.  Dr. Nebbari and Dr. Byadgi admitted to defrauding 
Medicaid, Medicare Part D, Medicare Part B, and various private health insurers of 
between $100,000 and $500,000.  The doctors admitted to directing unlicensed 
Suboxone coordinators to see, treat, counsel and prescribe Suboxone to opioid-
addicted patients. As part of the scheme, the doctors provided the Suboxone 
coordinators with pre-signed prescription pads and let the Suboxone coordinators use 
Google to find information on how to treat drug-addicted patients with Suboxone and 
how to determine the dosage of Suboxone for the prescription.  Both doctors were 
sentenced to 923 months imprisonment, 7 years probation, and 1,000 hours of 
community service to be directed toward those impacted by drug addiction.  
Additionally, both doctors were ordered to pay $198,189.06 in restitution to the 
Medical Assistance program, the Medicare Part B and D programs, and various 
private health insurance companies.  
Enforcement Actions Against Manufacturers  
Since first taking action against executives with Purdue Pharma in 2007, OIG has been at the 
forefront of enforcement efforts to hold opioid manufacturers accountable for the illegal 
marketing and distribution of opioids.  Notably, OIG has been heavily involved with 
investigation of Insys Therapeutics, which in June of this year agreed to a global resolution 
to settle the governments separate criminal and civil investigations.  Both the criminal and 
civil investigations, as well as the conviction of seven former executives (including the 
companys billionaire founder and CEO) in May, stemmed from Insyss payment of 
kickbacks and other unlawful marketing practices to illegally promote sales of Subsys, a 
sublingual fentanyl spray that is only approved by the Food and Drug Administration for the 
treatment of persistent breakthrough pain in adult cancer patients who are already receiving, 
and tolerant to, around-the-clock opioid therapy.  Many of these kickbacks allegedly took the 
form of sham speaker programs designed to reward high-prescribing physicians with jobs for 
the prescribers relatives and friends, and lavish meals and entertainment.  Insys also is 
alleged to have improperly encouraged physicians to prescribe Subsys for patients who did 
not have cancer and lied to insurers about patients diagnoses to obtain reimbursement for 
Subsys prescriptions that had been written for Medicare and TRICARE beneficiaries.  This 
was the first successful prosecution of top pharmaceutical executives for crimes related to 
the prescribing of opioids. 
 
Sentencing for the executives and the plea hearing for the global resolution have been set for 
next January.  As part of the criminal resolution, Insys will agree to a detailed statement of 
facts outlining its criminal conduct and pay a $2 million fine and forfeiture of $28 million, 
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while its operating subsidiary will plead guilty to five counts of mail fraud.  As part of the 
civil resolution, Insys agreed to pay $195 million to settle allegations that it violated the 
False Claims Act.  Insys also has entered into an unprecented 5-year Corporate Integrity 
Agreement and Conditional Exclusion Release with OIG.2 
 
OIG has been heavily involved with the indictment of pharmaceutical company Indivior and 
subsequent resolution with its former parent company,3 Reckitt Benckiser Group plc (RB 
Group) this year.  In April 2019, a Federal grand jury indicted Indivior for allegedly 
engaging in an illicit nation-wide scheme to increase prescriptions of Suboxone.  According 
to the indictment, Indiviorincluding during the time when it was a subsidiary of RB 
Grouppromoted the film version of Suboxone (Suboxone Film) to physicians, 
pharmacists, Medicaid administrators, and others across the country as less divertible and 
less abusable and safer around children, families, and communities than other buprenorphine 
drugs, even though such claims have never been established.  The indictment further alleges 
that Indivior touted its Here to Help internet and telephone program as a resource for 
opioid-addicted patients.  Instead, however, Indivior used the program, in part, to connect 
patients to doctors it knew were prescribing Suboxone and other opioids to more patients 
than allowed by Federal law, at high doses, and in a careless and clinically unwarranted 
manner.  The United States criminal trial against Indivior is scheduled to begin in May 
2020.  
 
In the meantime, in July 2019 RB Group has agreed to pay $1.4 billion to resolve its 
potential criminal and civil liability related to a Federal investigation of the marketing of the 
opioid addiction treatment drug Suboxone.  The resolutionthe largest recovery by the 
United States in a case concerning an opioid drugincludes the forfeiture of proceeds 
totaling $647 million, civil settlements with the Federal Government and the States totaling 
$700 million, and an administrative resolution with the Federal Trade Commission for 
$50 million.  The $700 million settlement amount includes $500 million to the Federal 
Government and up to $200 million to States that opt to participate in the agreement.  As I 
said at the time of the resolution in July, with the Nation continuing to battle the opioid 
crisis, the availability of quality addiction treatment options is critical.  When treatment 
medications are used, it is essential that they are prescribed carefully, legally, and based on 
                                                           
2 Because of the extensive cooperation provided by Insys in the prosecution of culpable individuals and its 
agreement to enhanced CIA requirements, OIG elected not to pursue exclusion of Insys at this time.  The CIA 
includes several novel provisions, including enhanced material breach provisions, designed to protect Federal 
health care programs and beneficiaries.  In addition, Insys admitted to a Statement of Facts and acknowledged 
that the facts provide a basis for permissive exclusion.  OIG did not release its permissive exclusion authority, 
as it generally does for CIA parties in False Claims Act settlements.  Instead, OIG will provide such a release 
only after Insys satisfies its obligations under the CIA (https://www.justice.gov/opa/pr/opioid-manufacturer-
insys-therapeutics-agrees-enter-225-million-global-resolution-criminal). 
3 In December 2014, RB Group spun off Indivior Inc., and the two companies are no longer affiliated.  
 
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accurate information, to protect the health and safety of patients in Federal health care 
programs.  
 
Exclusions Actions 
OIG protects federally funded health care programs by excluding certain dangerous or 
unscrupulous individuals and entities.  Excluded providers cannot receive payment from 
Federal health care programs for any items or services they furnish, order, or prescribe.  
OIGs criminal law enforcement efforts are complemented by its efforts to exclude problem 
providers from participating in Federal health care programs.  From the start of fiscal year 
2018 through the end of fiscal year 2019, OIG has issued exclusion notices to 1,348 
individuals (doctors, nurses, other providers, business owners/employees, etc.)including 
161 physicians, 896 nurses, and 87 pharmacists/techniciansand 15 entities (physicians 
practices and other businesses) because of conduct related to opioid diversion and abuse. 
 
OIGS EFFORTS TO COMBAT THE OPIOID CRISIS GO BEYOND 
ENFORCEMENT  
OIG continues to augment its robust portfolio of work related to the opioid crisis, with new 
and ongoing work that identifies opportunities to strengthen program integrity and protect at-
risk beneficiaries across both the prescribing and treatment dimensions of the crisis.  OIG 
currently has numerous opioid-related audits and evaluations underway covering multiple 
departmental programs, including questionable opioid prescribing patterns in Medicaid and 
Medicare; characteristics of Part D beneficiaries at serious risk of opioid misuse or overdose; 
beneficiary access to MAT through SAMHSAs Buprenorphine Waiver Program; 
SAMHSAs awarding of Opioid State Targeted Response (STR) grants; and opioid 
prescribing practices in the Indian Health Service.  
 
Prescribing Oversight 
In a series of reviews targeting provider oversight, OIG examined actions that selected States 
have taken using CDC and SAMHSA funds for enhancing prescription drug monitoring 
plans (PDMPs) to achieve program goals toward improving safe prescribing practices and 
preventing prescription drug abuse and misuse.  In another series of reviews, OIG identified 
actions that selected States took related to their oversight of opioid prescribing and their 
monitoring of opioid use.  Specifically, OIG reviewed the States' policies and procedures, 
data analytics, programs, outreach, and other efforts.  
  
Treatment Oversight 
SAMHSA estimates that 2 million people have an opioid use disorder related to prescription 
pain relievers and/or heroin.  MAT provided by opioid treatment programs (OTPs) is a 
significant component of the treatment protocols for opioid use disorder (OUD) and plays a 
large role in combating the opioid crisis in the United States.  SAMHSA issued final 
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regulations to establish an oversight system for the treatment of substance use disorders with 
MAT.  These regulations (42 CFR Part 8) established procedures for an entity to become an 
approved accreditation body, which evaluates OTPs and ensures that SAMHSA's opioid 
dependency treatment standards are met.  OIG has an ongoing review that examines whether 
SAMHSAs oversight of accreditation bodies complied with Federal requirements.  
 
Separately, OIG is reviewing potential geographic disparities in access to MAT through 
SAMSHAs Buprenorphine Waiver Program, which enables patients to access MAT through 
regular doctors officesinstead of limiting this service to OTPs.  In this review, we are 
determining how many providers have received waivers to prescribe buprenorphine for 
MAT and whether they are located in counties likely to have high needs for opioid treatment 
services.  
 
In July 2019, building on our extensive body of work related to the opioid crisis, which 
includes annual data briefs on opioid prescribing in Medicare Part D, OIG released a data 
brief on the 2018 Part D data, Opioid Use Decreased in Medicare Part D, While Medication-
Assisted Treatment Increased.  We found that nearly 3 in 10 Medicare Part D beneficiaries 
received an opioid in 2018, a significant decrease from the previous 2 years.  At the same 
time, the number of beneficiaries receiving Part D drugs for MAT for OUD and the number 
of beneficiaries receiving prescriptions through Part D for naloxone both increased.  The 
number of beneficiaries at serious risk of opioid misuse or overdose also decreased, along 
with the number of prescribers with questionable opioid prescribing for these beneficiaries.  
Despite this seeming progress, concerns remain.  About 354,000 beneficiaries received high 
amounts of opioids in 2018, with almost 49,000 of them at serious risk of opioid misuse or 
overdose.  Further, about 200 prescribers had questionable opioid prescribing for the 
beneficiaries at serious risk.  
The data briefs help OIG and OIGs law enforcement partners investigate high prescribers 
for possible fraud.  We are also referring actionable information with program integrity 
partners including the Centers for Medicare & Medicaid Services (CMS), States, and the 
Healthcare Fraud Prevention Partnership (HFPP), so that they can use tools at their disposal 
to address high-risk beneficiaries and prescribers that have questionable billing.  
 
Data Analysis To Identify Questionable Prescribing, Dispensing, and Utilization of Opioids  
OIG uses data analytics to detect and investigate healthcare fraud, waste, and abuse.  We 
analyze billions of data points and claims information to identify trends that may indicate 
fraud, geographical hot spots, emerging schemes, and individual providers of concern.  At 
the macro level, OIG analyzes data patterns to assess fraud risks across Medicare services, 
provider types, and geographic locations to prioritize and deploy our resources.  At the micro 
level, OIG uses data analytics, including near-real-time data, to identify potential fraud 
suspects for a more in-depth analysis and efficiently target investigations. 
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Although OIGs increased utilization of data analytics enhances our enforcement and 
oversight efforts, there are still areas where we lack access to reliable data that hinders our 
work.  For example, historically, Medicaid data have not been complete, accurate, and 
timely, and have not been adequate for national analysis and oversight.  In August 2018, 
CMS announced that all States were submitting data to the national Medicaid database, 
known as the Transformed Medicaid Statistical Information System (T-MSIS), and that it 
was prioritizing T-MSIS data quality.  OIG has a history of advocating for complete and 
accurate Medicaid data and is now monitoring whether the quality of T-MSIS is suitable for 
program enforcement and oversight activities.  In fact, we have recently completed work 
assessing the completeness of variables needed to monitor national opioid prescribing in 
Medicaid.  Complete and accurate T-MSIS data are critical for effective monitoring of the 
opioid crisis in Medicaid, as well as general program integrity efforts.       
 
OIG MAXIMIZES IMPACT THROUGH STRONG COLLABORATION WITH 
PUBLIC AND PRIVATE PARTNERS  
In addition to the Strike Force Operations and Opioid Fraud and Abuse Detection Unit law 
enforcement collaborations addressed earlier, OIG works closely with several HHS agencies 
on initiatives to prevent prescription drug and opioid-related fraud and abuse covering both 
the prescribing and treatment dimensions of the opioid crisis.   
 
Collaboration With CDC on Opioid Rapid Response Teams  
As our enforcement and oversight efforts to address the opioid crisis have expanded, we 
have come to understand the impact our enforcement work can have on the beneficiaries we 
serve.  We recognize that when a clinic whose patients are prescribed opioids is shut down , 
access to care for patients, including many suffering from substance use disorders, can be 
disrupted.  Rather than leaving these patients to potentially turn to another fraudulent 
provider or street drugs to meet their needs, we believe that it is vital that those struggling 
with substance use disorder have access to treatment and that patients who need pain 
treatment do not see their care disrupted.  The potential dangers of abrupt opioid withdrawal 
are well established and thoughtful dose tapering may help patients discontinue opioid use 
safely.  
 
Ensuring that these patients have continuity of care requires a collaborative approach with 
our Federal, State, and local partners, which has led OIG to work closely with CDC on 
standing up their new Opioid Rapid Response Teams (ORRTs).  The mission of this team is 
to work alongside law enforcement partners to address disruptions in care after a clinic 
closure by providing support to State, local, and Tribal jurisdictions; providing clinicians 
with resources; conducting targeted outreach; expanding access MAT; and building response 
capacity.  OIG worked closely with CDC in the planning and development of the ORRTs.  
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We advised them on protocols, connected them with other law enforcement partners, 
prepared data and support/educational materials, and continue to coordinate with them on 
deployment preparations to help focus their efforts to maximize impact.  As part of the 
recent ARPO takedowns, OIG and our law enforcement partners coordinated closely with 
the CDC to make sure they were able to share their technical expertise with State and local 
officials and ensure that all impacted jurisdictions had sufficient response capacity to address 
the impact of takedown operations.  OIG will continue to work hand-in-hand with our public 
health partners at the CDC to ensure access to treatment and continuity of care for 
beneficiaries impacted by our opioid-related law enforcement efforts moving forward.   
 
Other Collaboration With the Department  
OIG collaborates with a number of other HHS agencies, including CMS and the Agency for 
Community Living (ACL), on fraud and opioid-related initiatives.  OIG collaborates with 
CMS and ACL to educate providers, the industry, and beneficiaries on the role each one 
plays in the prevention of prescription drug and opioid-related fraud and abuse.  We share 
our analytic methods and data analysis with CMS and work together to identify mitigation 
strategies and develop followup approaches to deal with the prescribers and at-risk 
beneficiaries identified.  OIG engages ACLs Senior Medicare Patrol and State Health 
Insurance Assistance Program through presentations on the prevention of fraud, waste, and 
abuse. 
 
Additionally, in June 2018 OIG published a data analysis toolkit that our Federal, State, and 
private insurance partners can use to translate opioid prescriptions into a morphine 
equivalent does (MED) and identify patients who are at risk of opioid misuse or overdose.  
The CDC posted the toolkit to its public website aimed at researchers and analysts. 
 
The Healthcare Fraud Prevention Partnership and the National Healthcare Anti-Fraud 
Association  
OIG also engages with private-sector stakeholders to enhance the relevance and impact of 
our work to combat healthcare fraud.  The HFPP and NHCAA are public-private 
partnerships that address healthcare fraud by sharing data and information for the purposes 
of detecting and combating fraud and abuse in health care programs.  OIG is an active 
partner in these organizations and frequently shares information about prescription-drug 
fraud schemes, trends, and other matters related to healthcare fraud.  We also share our 
expertise in data analytics, including the aforementioned toolkit and specific data resulting 
from takedown operations.  Through our partnership in the HFPP and collaboration with the 
NHCAA, OIG strives to educate and empower private-sector insurers to best leverage data 
analytics and intelligence from the field to protect their own insured customer population.  
Likewise, OIG benefits from hearing directly from private and public partners about 
schemes and techniques used by other payers to combat healthcare fraud.  
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CONCLUSION 
OIG has made combating the opioid crisis a top enforcement and oversight priority. We will 
continue to leverage our analytic, investigative, and oversight tools, as well as our 
partnerships with law enforcement, the program integrity community, and the Department to 
maximize our efforts to address both the prescribing and treatment dimensions of the crisis.  
OIG will remain vigilant in identifying and investigating emerging opioid fraud trends, 
especially schemes involving patient harm and abuse. 
 
Thank you for affording me the opportunity to discuss this important topic with you.  
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