Welcome to today’s episode where we dive deep into one of the most critical yet often misunderstood areas of healthcare compliance: corresponding responsibility. I’m joined by Michael Staples, a healthcare regulatory compliance expert whose fascinating journey from law enforcement detective to compliance specialist gives him a unique perspective on this complex topic.
n our conversation, Mike highlights a troubling reality: regulatory agencies often fail to distinguish between innocent mistakes and criminal intent, leaving non-criminal healthcare professionals fighting their cases in court where juries must apply common sense to see the truth. He shares practical directives for both pharmacists and physicians to protect themselves while fulfilling their professional obligations.
Whether you’re a healthcare provider, pharmacist, or compliance officer, this episode offers clarity on navigating the complex landscape of corresponding responsibility. So stay tuned for this informative discussion that could help protect your practice and your patients.
Transcript
Terri Vidals
Welcome listeners to Diversion Insights. My guest today is Michael Staples. Mike is a healthcare regulatory compliance expert. His journey to present day work is a very interesting one, so I want to start there. Mike, give us a bit of your story of how you went from detective to compliance expert. And I should say, welcome to the podcast.
Michael Staples
Oh, thank you, Terri. Thanks for having me. Well, my journey was an interesting one. I never thought I would get to where I’m at now. However, I started my career as a police detective and spent about 10 years doing that with a focus on drug crimes. And I started getting interested in professional crimes as far as like pill mills and doctors illegally prescribing cases towards the end of my career and a position came open with the state medical board as an investigator.
Michael Staples
So I applied and took that position and then I was with the state medical board approximately 10 years and then I left the state after investigating, you know, licensees, both doing criminal investigations and regulatory actions, became director of compliance for a large pain clinic in the Cincinnati, Ohio area and started teaching cme, which I did a little bit when I worked at the state. I taught CME on parent behaviors and documentation. So I kind of transitioned when I left the state and doing more private cme. And actually before COVID we had a very robust controlled substance prescribing course that I created along with some attorneys and medical professionals.
Michael Staples
But after Covid, that kind of ended all the in person CME events there for a while and I started doing more and more with consulting, helping physicians get in compliance or if a physician actually got into trouble for, you know, allegedly improperly prescribing controlled substances or for some alleged fraud, I would help their attorneys and help the physician not only get in compliance, but also build up a good solid defense, you know, for the physician’s case. And you know, since then I’ve been sworn into federal court as a healthcare compliance expert and have done hundreds of consultations and also been director of compliance for a few national companies, including a national telehealth company, pain clinics in other states as well.
Michael Staples
Sometimes they’ll contract with me to be their compliance officer because it gives more credence having a third party compliance officer than someone that’s, you know, could be perceived as biased working inside the office as the compliance officer.
Terri Vidals
Right? Yeah, absolutely. Yeah, that makes sense. Okay, so you’ve learned the clinical aspect of healthcare along the way, I would assume?
Michael Staples
Absolutely. Working in a two large pain clinics for probably a total of five years has gave me valuable insight into the medical clinical side of not only prescribing but just, you know, medical operations in general, which has helped me become way more versed in not only compliance but also helping physicians build defenses. And, and also common sense because a lot of experts for the government and experts for other sides, they don’t look at the common sense factor when it comes to patient care and you know, providers, you know, being compliant with the rules and laws. There’s, there’s compliance and then there’s common sense and there has to be a correlation.
Terri Vidals
Right? Yeah. So let’s talk about that. I’ll be curious to hear if you. Well, let’s just do that now. Do you, when it comes to court cases and legal cases, I don’t know if common sense always wins out. Do you, do you see that play itself out very well?
Michael Staples
It does when you have the right legal counsel in the right jury. You know, common sense doesn’t play out if the case is presented directly to a judge because the judge is just going to interpret the letter of the law.
Terri Vidals
Right.
Michael Staples
And not take in consideration, you know, common sense. But when you are playing to a jury, the juries, you know, they’re humans, they’re everyday citizens and they’re going to use common sense in their reasoning. And so therefore common sense, you know, in a lot of these cases can be a strong defense. You know, when you have a physician that has no prior criminal record, has never been in trouble for in their life, and their accusing him of being some mass drug trafficker because he has a certain number of patients on controlled substances that have documented medical reasons, you know, common sense would say, is this person really a drug trafficker? Because, you know, they have no criminal record, they’re not making any money besides what little co pays they’re getting or what little reimbursement they’re getting from Medicare, Medicaid.
Michael Staples
So, so common sense, you know, to me would play out that, no, this person might be a little naive, you know, as a prescriber, but it’s definitely doesn’t have a criminal bone in their body.
Terri Vidals
Right, okay. Yeah, we’re going to talk about that too. Naive versus criminal. But I want to start with so corresponding liability. That applies to pharmacists and physicians as well. So let’s talk about that first four our listeners that maybe are not familiar with that term. What is that?
Michael Staples
Well, physicians and pharmacists have a corresponding 50% liability, you know, when they write a prescription, especially controlled substance prescription. So the physician writes the prescription and then takes it. You know, the patient takes it to a pharmacy. Well, the filling pharmacist has a corresponding liability to that prescription. And a lot of people don’t really understand it, you know, including a of lot of people at the government level. A pharmacist is really supposed to just verify that the prescription is legit. Okay? But the government has unfairly targeted pharmacists and got it to a point where they make the pharmacist feel like they have to do the medical decision making and medical necessity, which, you know, they’re not technically trained to do. You know, they’re trained, is this drug a good fit, you know, for this condition.
Michael Staples
So, you know, it’s really become, you know, a mess out there with, you know, the government targeting physicians and pharmacists that are doing nothing more than their job. You know, they want doctors to be detectives and pharmacists to be full time detectives when they already have incredibly busy schedules. Both, both professionals. So you have to be able to protect yourself and protect your license while trying to be the best detective you can as a licensed professional with no experience investigating these things, which is completely, you know, unfair. So that liability, you know, if a, if you have a physician, then that is a bad player. Let’s just pretend that, you know, he is a bad player. He is just selling prescriptions for cash. You know, people walk into their office, the traditional pill mill type structure. People walk in his office, he.
Michael Staples
They hand him 500 in cash, or they don’t even see him. They might hand his front desk staff $500 in cash and he writes them a prescription, more than likely for a drug combination, you know, an opiate, a benzo and a muscle relaxer, preferably a soma Houston cocktail, Las Vegas cocktail, Portsmouth cocktail. It has many names. So he hands them these prescriptions for a cocktail. They take it to the local CVS pharmacy. The pharmacist looks at it and says, oh, well, this is a cocktail, okay? If that pharmacist just fills those three prescriptions without doing any due diligence or anything regarding his 50%, you know, his, you know, liability, 50% corresponding responsibility, that pharmacist could be charged, you know, with a crime. Because they’ll basically say, you know, you knew this was a drug cocktail.
Michael Staples
You didn’t look into it, you didn’t verify legitimacy of this. And so what licensees need to do, both doctors and pharmacists, is making sure that they document these things. So, you know, if you’re a physician now, not Mr. Bad Physician, that we just talked about. But a normal good physician, you know, you want to make sure in the medical records that you’re documenting, you know, the medical necessity of the drug, the lack of any adverse or side effects. Because, you know, I’m going to be brutally honest with you, there are patients out there that are on that cocktail and have been on it for 20 years with no adverse effects, hold down great jobs and provide for their families. And without that cocktail, they would not be able to function. They’ve tried it. You know, I’ve seen the records.
Michael Staples
You know, I’ve been in thousands offices, I’ve reviewed tens of thousands of medical records and I’ve talked to some of these patients and these patients, you know, they have no criminal history, no compliance issues. You know, all good
urines, all good, you know, PMP checks. But there are patients that actually need this type of combination. Not saying I, I endorse it in any way, however.
Terri Vidals
Yeah, it’s not an automatic red flag. Don’t fill.
Michael Staples
Correct, correct. It needs to be looked into. And that’s where the corresponding, you know, responsibility, you know, lies is doing your due diligence, you know, whether you’re a prescriber or a pharmacist. You know, and a lot of pharmacists make a mistake because they call the physician and they start questioning their medical decision making instead of just verifying the reasons why the prescription was issued. You know, because most laws regarding corresponding responsibility, you know, state that the pharmacist has to verify the prescription, not, you know, question the doctors. Yeah. You know, and you know that’s where a lot of problems lie. But the government sometimes will use this in court improperly and they will fault a pharmacist for not doing more of the medical decision making challenges, which is not their job. You know, they already have a, they’re already busy enough.
Michael Staples
Really what they should be doing is, you know, documenting and verifying that. Number one, the prescription is legitimate. It was issued by the provider. It’s not a counterfeit prescription. You know, and a lot of times they can do that by contacting the physician’s office and asking to speak to the physician or if they trust the staff, you know, getting that staff and having, you know, the original faxed over, if it’s a paper script or just verifying that, you know, this patient is seen, you know, and the prescription was issued by the prescribing physician.
Michael Staples
The second thing, you know, they want to, should verify is the PMP report, you know, so the pharmacist should run a PMP report, you know, on the patient to make sure, you know, he’s number one, he’s not getting it from somewhere else that he’s been getting the same dosage for, you know, a long time, etc. And sometimes you even go a little step further. And when I do consults for pharmacies, sometimes that are being scrutinized, you know, by the government or the state, sometimes I, I advise them how to check criminal records, you know, of patients. And I don’t want pharmacists checking criminal records on every single patient that walks in the door. But there are, but there are free resources out there that I help pharmacists know about and also check.
Michael Staples
So if they have an issue, especially, you know, let’s take one of the worst drugs that the government hates, okay? And it’s always scrutinized. Oxy. Oxy 30s, you know, 30 milligram oxycodone. It has a very high resale value on the street. Sometimes dollar up to $2amilligram, you know, street value. And it’s, you know, highly sought after. But again, there’s some people that’s been on that drug for 20, 30 years without any adverse side effects. No sedation, no, you know, nothing that would cause them any problems. They’re holding down jobs, they’ve had no criminal record, and they’re compliant in every possible way. So we don’t want to stop that person from getting a legitimate script just for the sake of it being a oxy 30, you know, and that’s what I see a lot with these investigations and these state actions.
Michael Staples
Just the fact that they’re on an oxy 30 is crazy to the government. However, there are plenty of people that need this drug, and I’ve interviewed them myself, I’ve looked at their medical records myself and scrutinize these people both as a former investigator and as a, a private consult, you know, and it’s sad because I’ve actually met a guy that had a 10,000 morphine equivalent dose that his. He was on that many oxy. OxyContins, his morphine equivalent dose was 10,000 a day.
Terri Vidals
Holy cow.
Michael Staples
Yeah, and that was as an investigator. And, and I’ll be honest with you, is like, went out to his house because, you know, this physician actually used to speak for Purdue Pharma, and he titrated this guy up to these high levels. And went out to his house on a surprise visit and counted his medication and watched him dose and all of his medication was accounted for and he dosed. I’m talking about handfuls, you know, of medication. It was the craziest thing I ever seen. And, you know, we sat there and talked to him for a good solid hour after that. There was no change in his demeanor, no any, you know, effects other than he says he didn’t have the, doesn’t have the pain. You know, he can cope with the pain. He says it’s not 100% gone, but he doesn’t have the pain.
Michael Staples
But yeah, 10,000 morphine equivalent dose. You know, one of the patients I saw, and it’s crazy, but it got to the point that no one would prescribe to him because of all the scrutiny. So I don’t know whatever happened with this guy because I left the state, but I, I’m sure, you know, it didn’t end well for him because, you know, you can’t go from those high levels down to a low level unless you’re completely detoxed, you know, and then it still might not even work. And you can also kill somebody from dropping those levels like that, you know, from the stress on their body, you know, from the sudden pain and everything. It’s scary. But, you know, pharmacists should make sure they’re covering their corresponding responsibility. And you’ve got to make sure you document.
Michael Staples
If you don’t document, it didn’t happen, just like in medical records. So when you’re covering yourself on corresponding responsibility, you want to make sure you keep the documentation. Don’t just do it and issue the prescription, especially if it’s a first time patient coming to your clinic. You know, we. I use a checklist sheet sometimes that I give to my pharmacist and it basically addresses all the red flags and it makes sure that they verify all the things that, you know, the government would look at to make sure this is a legitimate medical prescription, including, you know, making sure that the patient has the right ICD10 codes, you know, for the pain. You know, the patient has no signs of aberrant behavior.
Michael Staples
They’re not coming into the pharmacist, you know, appearing sedated or intoxicated, things like that the, it’s documented that the prescription monitoring report was looked at. It’s documented that the provider’s office was contacted and they verified the prescription. Just basically covering yourself. And that way, if a government entity would ever come in questioning your filling of that prescription, you can pull out your basically compliance folder and show every time you’ve done this for every patient. And, you know, if they have a particular patient, you can go right to that. That sheet and say, here’s where I did my due diligence and did my corresponding responsibility by verifying that this prescription wasn’t medically inevitable. I’m not technically not a medically necessary, but, you know, a verified prescription.
Terri Vidals
Yeah.
Michael Staples
Valid prescription. Yes.
Terri Vidals
So what would you say to the pharmacist that does all of that, but still, either they’ve seen prescriptions from a particular physician, the physician’s office will answer the phone and will say, yes, I wrote that prescription. But either this local pharmacy is seeing repeated patients. There’s just something about it that they’re like, everything. I can check on this checklist and file this away, and I did my due diligence, but I really think something is going on here.
Michael Staples
Yeah. And sometimes those thoughts are correct and sometimes they’re wrong. But do we really want to punish the patient based on, you know, a gut instinct or, you know, a thought, a consideration? So you got to do your due diligence. However, you know, my advice at that point would be look into the physician. You know, check the board website, see if there’s any current board actions against the physician for inappropriate prescribing or any issues related to his prescribing. And then you can kind of leverage that to possibly, you know, not fill the prescription or refuse to fill a prescription. Because if you have a lot of documented evidence that a physician is not doing what they’re supposed to be doing, then by all means, you. You should get, you know, not fill that prescription. But you could.
Terri Vidals
You could also add it to your checklist to say, I went the extra mile. And there don’t seem to be anything against this physician’s license, so.
Michael Staples
Correct. And you shouldn’t. You shouldn’t be denying patients on a gut instinct. I mean, it’s. It’s different if they come in with track marks on their arm and. And they’re slurring their words and, you know, where’s my oxycode? On. You know, that’s. That’s a lot different.
Terri Vidals
But what about the patient that is the opposite, where they come in and. And they’re not impaired or slurring or they’re very clean and, you know, they look professional, and they’re not taking it for themselves. They’re selling it.
Michael Staples
Yeah, that. That does happen. But again, you know, the only thing you can do is what’s available to You, I mean, you know, you can’t babysit these patients. You can’t conduct surveillance on these patients. You know, and the government, sometimes they do look at it like, you know, they expect you to be in there in their house, 24 hours a day, watching what they do. You know, you can’t turn a blind eye. But at the same time, when you’ve done all your due diligence, what else can you do? Because. Yeah, okay, well, I have a hunch that this patient is selling their drugs. Well, what if your hunch is wrong and you start denying these patients their prescriptions?
Michael Staples
They have an insurance that’s locked into, say, CVS Pharmacy, just as an example, and a lot of insurances now are locked into certain pharmacies, so they can’t get their prescription. What are they going to do for their pain? Unfortunately, I’ve seen it a hundred times. They go to the street and try to buy. Buy the medications, which sometimes are counterfeit and contain, you know, illicit fentanyl, and they overdose and they die, you know. You know, and that’s not what we want. We want people to do their due diligence, you know, as prescribers and as pharmacists. But at the same time, you. They cannot be detectives. 24 7, right?
Terri Vidals
Yeah. And I guess, like, I, I know of a situation. This was years ago, and this was a patient that was coming in for the fentanyl lollipops, and the buyer was noticing that each month that the patient came in, they just came in a day or too early. Right. So now you fast forward six months and they’re very early, but it was just a day or two early. And there were other things I believe that they were getting in addition. But this person got more and more dressing better, looked more professional as the months went on that they came in. And it’s like, wait a minute here. So they reached out to the physician to express the concern, and I don’t believe that person was being drug tested for anything. So in collaboration with.
Terri Vidals
With the pharmacy, then the physician’s office instituted the drug testing and found that everything was clean. This patient wasn’t taking those.
Michael Staples
Right. And that’s why there should be good, solid communication between the physician and the pharmacist. I will say that if you, as a pharmacist, contact a provider’s office and the provider won’t get on the phone, I mean, most states actually have rules and laws at state. They have to answer the call. You know, that would be a red flag to me if I was a pharmacist. You know, now there are some physicians that have had bad experience with pharmacists questioning their medical decision making. So they’re hesitant to get on the phone. But if I was a pharmacist, I mean, obviously I would be very professional and courteous. And I tell my. The physicians to be the same way. You know, it doesn’t ever pay to be rude to anybody. It’s just going to.
Michael Staples
No matter what side you’re on, it’s just going to initiate a complaint to a government office, you know. Right. So always be professional. But, you know, that’s why there has to be good communication. And that example you just gave is a prime example of pharmacists and physicians doing what they’re supposed to be doing. Because, you know, why this guy or girl wasn’t being drug tested is beyond me. Because, you know, that type of dose, you know, most state rules, at least, you know, actually some states actually mandate urine drugs, drug screening, not all, but from a standard of care, they should be, should have been drug testing that patient when they, you know, started aim, and also for monitoring as well.
Michael Staples
But playing devil’s advocate, what if that patient started getting those fentanyl lollipops and because he was able to control his pain, finally was able to go get a job and was able to buy nice things, you know, you see, I mean, you know, there’s a flip side to these things, you know, and that’s why red flags were never, you know, never meant to be evidence, you know, in a court of law. Because red flags are just something that’s supposed to bring your attention to something and have you look into it.
Terri Vidals
That’s true.
Michael Staples
You know, it’s. You know, I recently testified at a federal court case where, you know, the prosecutor was alleging the doctor was a drug trafficker because he had patients coming from Florida to Kentucky. Okay, but when I testified, you know, they asked me, you know, Mr. Staples, don’t you think that this person is a drug trafficker if he’s got patients coming from Florida to Kentucky? And I, I advised him, no, sir, I don’t. Which really confused him. But I went on to explain that, you know, Kentucky, like Ohio, Indiana or Snowbird states, and a lot of these patients, they go south for the winter. And because of these rules and regulations and government scrutiny, a lot of these providers in Florida will not temporarily take on their pain medication.
Michael Staples
So these patients that have homes in Florida during the wintertime, a lot of times they have to travel back, you know, to Ohio or to Kentucky or to Indiana to get their control substance prescription. And that’s something that should be looked into. So if there is a red flag, you do have a patient coming from Florida and you know, they go to there for, you know, to be a snowbird, that’s one thing, you know. But if they’re coming up every single month, they live in Florida permanently and come into Kentucky. No, you should not be filling because, you know, obviously something’s going on because they’re driving or flying past about, you know, 500 pain doctors to get back to Kentucky.
Terri Vidals
Right, right. Which again though goes to points to. Physicians aren’t detectives either. Right. You can only believe what you’re told. So aside from the drug testing, legitimate, you know, tests that you order, mris, what have you, those types of things, what other things can physicians do? Because I mean, they could be duped as well. I mean, you only know what I’m.
Michael Staples
Going to tell you again. You know, making sure that they document. You know, I always tell physicians, you know, in some EMRs, they already have this, but you know, basically create a compliance section in the node or you know, where you’re checking, you know, the urines, the PMP reports. I always tell all my physicians that I consult for to check the PMP every single visit. You know, don’t wait until, you know, some states, you know, it’s every 90 days or if you change the prescription, you should be checking that prescription or that patient every single visit. Because number one, the PMP is free. It’s not costing you a thing to check it. And it literally takes two seconds. In most of the states you can have a delegate run the report for you. It’s going to take you two seconds to look at it.
Michael Staples
Okay. And you’re going to document that every single visit, you know, check the PMP and it was compliant, you know, or non compliant. And if it’s not compliant, you better be able to justify that or explain that or you know, what you did, you know, in the course. Urine drug tests, you know, they should be random. You know, a lot of these practices I go into, the doctor gives them once a year or once every three months like clockwork. You know, if they, if they are a bad patient and they know that you’re going to drug test them every three months, they’re going to party or sell their drugs for the entire three months and then they’ll keep a few back to take right before their three month visit.
Michael Staples
You know, and I’ve seen it from working in, you know, pain clinics, you know, I even seen where, you know, EMRs are great and you know, giving patients access to patient portals are fantastic as well. However, you know, a lot of physicians would write in the not you’re in drug screen at the next visit. Well, the patient can log into the portal and see right there that they’re going to have a urine drug screen or a pill count next visit. So you also got to kind of be careful, you know, if you got somebody that you’re scrutinized, you know, want to scrutinize, that you don’t give yourself away, you know.
Terri Vidals
Right, right. Interesting.
Michael Staples
But, but just like the medical necessity and the medical decision making, everything must be documented. So all your barency checks, you know, and if you got a real bad patient that you think, you know, like, you know, I tell physicians if they do have that feeling that they’re bad, you know, they watch them, you know, jump out of the car when they come to the office like they have no pain. And then when they get to the office, they’re walking like they’re crippled and can’t walk at all. You know, things like that are, you know, obvious red flags that need to be, you know, checked further. And, you know, you must be random in these checks and you must document everything. And there’s other things that you can do.
Michael Staples
Just like I instruct the pharmacists about checking criminal records, I also instruct the physicians, you know, when they have cases where they can’t quite put their finger on it, you know, to check criminal records. You know, if you see a criminal record when they was in college for, you know, smoking marijuana or intoxication. No, you don’t count that.
Terri Vidals
Circumstances and common sense come in again.
Michael Staples
Yeah, exactly. Yeah. You want to look for recent episodes of, you know, drug trafficking, something that, you know, they’re doing, or felony drug abuse, you know, not something where, you know, they get stopped for marijuana, you know, or something from their college ages. Just like, you know, we talk just common sense. And you want to make sure you know, you document all that and, you know, it’s appropriate, you know, it’s, you know, pertinent that you’re seeing these patients. You know, if you have a patient on a controlled substance, especially, you know, a higher dose opiate, you know, you should be seeing these patients every month, you know, just to make sure, number one, you know, there’s no adverse effects, there’s no side effects. But also to monitor their compliance. You can’t do that.
Michael Staples
When you’re seeing someone every three months or every six months, you’re not going to be able to adequately monitor their compliance, and they’re going to use that against you when you do get into court, you know, unfortunately, they’re going to be, you know, say, well, you know, he’s not seen. Hasn’t seen this patient in three months. They don’t know what he’s doing, or hasn’t seen this patient in six months. You know, the physician don’t care what they’re doing. And, and, you know, there’s no way, like I said, you’re. You’re back to that point where the patient knows that you’re going to urine test them because they’re only seen four times a year. So, you know, they. They know they’re not going to be called in for random urine.
Terri Vidals
Yeah.
Michael Staples
And, you know, and there’s other things you can do. Pill counts are very inconvenient for both the physician and the patients. But there are occasions that I do believe they’re necessary. And with today’s technology, I actually developed this during COVID doing pill counts over FaceTime.
Terri Vidals
Sure.
Michael Staples
So, you know, I would contact the patient, say, you know, I need to do a pill count. They would give me a thousand excuses why they couldn’t come in. I would say, oh, you’ve got an Apple phone. Let me. Let me FaceTime you. And then you just lay out the pills on the table, show me the prescription label, and then a lot of times you would just take a screenshot, you know, once they’ve laid them out on the table, you know, and obviously when you’re doing a pill count, you want to make sure the identifiers on the pills match the identifiers on the bottle. But, you know, I’ve had many patient or physicians now do those surprise pill counts, you know, via FaceTime or.
Michael Staples
Or, you know, any video link, because, you know, then you can see without too much inconvenience, you know, whether the patient is compliant or not. But, you know, pill counts, like I said, they are very inconvenient. People do work. People do go on vacations, you know, like before COVID when I was director of compliance, I called a patient for a pill count. He said, hey, I’m in the middle of Lake Cumberland and my friend’s boat fishing. Like, there’s no way I can get there by the close of day, because I would always call them first thing in the morning, have them come in by the end of the business day. So, you know, I advised him, hey, you Got a smartphone. He’s. Yes.
Michael Staples
I said, do me a favor, Take a selfie holding three fingers up on the lake show and send that to me. So within two seconds, boom, I got a text. It was him, you know, in the middle of the lake, you know, holding three fingers up. I said, okay, you know, next time we have an issue, we’ll call you for a pill count. But, you know, this time, you know, we’re going to give
you the benefit of the doubt, right? Because, you know, again, common sense. I mean, he was right. He was honest about where he was. So. So we, you know, let it go. But then I had another patient that I called for a pill count. He said, well, I’m at. In Nashville at my aunt’s house. And I said, okay, well, what’s the address? You know.
Michael Staples
And he said, well, I don’t know. It’s my aunt’s house. You know, I said, we’ll walk out the front door and look at the numbers on the mailbox or on the house and look at the street sign and tell me the address. And, you know, thousand excuses why he couldn’t do that. I said, okay, give me a landline, you know, at her house. Give me your. Well, she don’t. I don’t know her phone number, you know, and it just round and round until, you know, he. I finally, you know, I had to use detective skills. But I finally got him to admit that he was not in Nashville. He was out of his prescriptions. You know, he had obviously either overused or sold. So we just went ahead and discharged him from the practice. But.
Michael Staples
But again, common sense, you know, on those things and, you know, documentation of, you know, not only the urine drug screens and whether they’re compliant or not in the PMP and possibly pill counts, but also make sure you’re documenting, you know, about the effects of the medication, that there are no sedation or side effects, because that’s something that will come in play if you ever do get in trouble is they’ll. They’ll, you know, because they’re. They’re going to accuse you of over prescribing and the patient overusing. Well, if a patient. You are really over prescribing, the patients overusing, they should have adverse health effects, you know, so you want to make sure all that’s documented, you know, in the chart as well.
Michael Staples
Also, you know, document the analgesia of the drug, you know, from whether it’s, you know, they’re getting at least, you know, 30% relief from the medication because, you know, if they’re coming in every single visit, their pain is 10 out of 10. What’s your pain on the medication? 10 out of 10. Why are we giving them medication to begin with? You know, because there is no improvement in their lives. You know, the. There has to be a reason a patient gets pain medication. So there should be, you know, some proof of the efficacy of the drug, you know, showing that the patient was able to achieve good analgesia.
Terri Vidals
Yeah. Okay, well, that takes. Yeah, it. It’s a lot of physicians to.
Michael Staples
That’s just the tip of the iceberg. You know, the things that they look at and the things that, you know, if I come out and do a consult for a physician or a pharmacist, the things that I point out to them and. And make them aware of and, you know, how to better their documentation and better their checks so they can.
Terri Vidals
Right.
Michael Staples
Not have. Not have to stress over that.
Terri Vidals
Yeah. Or hire a real detective.
Michael Staples
Yeah, well, no, you can’t do that. We had. We got. There’s a case pending in Pennsylvania. Pennsylvania, where a group of pain physicians hired ex narcotics detectives to screen their patients, you know, prior to them seeing them. Great idea. And actually the state loved it and had them testify in front of the state legislature and everything. However, when it comes down to it, they were. They’re trying to say that the detectives, ex detectives, were making medical decisions on the patients, which is not true. You know, they’re just checking to make sure they wasn’t drug traffickers or, you know, had any issues. So you can’t win sometimes, you know, regardless of what you do. But you can, you know, just do your best to show that, you know, you’re not a criminal, you have no intent.
Michael Staples
You’re just trying to help your patients, whether you’re a pharmacist or a physician. Right.
Terri Vidals
And really keep your records. Do you have a feel for. You know, we hear it in the news, right. When one of these things goes down and no pill mill and what have you. What percentage of the time do you see a case where it that they didn’t. They may not have followed every single regulation or they may have not kept as good of records, so they could certainly have done better, or there may have been some fault in their record keeping, but they’re not criminals. What percentage of the time do you see that? Do you have.
Michael Staples
The cases that I’ve been involved with, you know, as a health care compliance consultant, 100%. You know, it’s really scary. You know, we had a Physician in Kentucky, Internal medicine Physician in. It was during COVID And it’s one of those situations where the documentation could have been better, but an undercover agent was sent in and the agent was complaining of pain every single time. You know, and back when we did Dr. Investigations, we would tell the undercover not to complain of pain because, you know, doctors have a duty to treat medical conditions. So you don’t want to get them in a situation where they’re kind of like professionally bound to do something for you.
Michael Staples
You know, we would typically get the doctor in the room alone and then say, look, doc, you know, this medication just makes me feel good, you know, and you know, such and such patient friend of mine told me that, you know, you would be willing to give that to me, you know, or whatever, because that’s the kind of people that we want to take off the streets, the ones that are actually giving the medication for a non medical purpose. So in that situation, and they’ll just do it.
Terri Vidals
Like they don’t even.
Michael Staples
And they just do it. And they did do it. They did some of those pill mills in Portsmouth, Ohio, back when I was, you know, with the state, you would basically walk in and order from a menu, you know, so, you know, they would have all the drugs and the costs, and you never saw a physician. You know, the front desk was filling out, you know, pre signed prescriptions, you know, filling out the body, getting them to you. You was given cash. Most of them, if you’re lucky, they had a bathroom scale. They had no medical equipment. You know, I’ve not seen a true pill mill in years. You know, because, you know, the government, most state governments have enacted, you know, took away like, you know, the corporate practice of medicine and enacted regulations on who can have a pain clinic.
Michael Staples
And there’s so much inspections now relating to pain clinics and pain management that it really cut down on the true pill mills. Now, are there still some bad actors out there? Yes, you know, there’s still prescribers that, you know, may have addiction issues themselves. And so they kind of do a little bad thing so they can get the drugs that they need for their addiction, or they use their position of power to obtain sexual favors from patients. You know, in exchange, they give them, you know, control substances. And those providers or prescribers are the ones we should be targeting and they should be taken out. But the ones like the doctor in Kentucky, he was just, you know, not really good at documenting. And especially it was during all the hectic, you know, Covet time.
Michael Staples
And so he had a lot of patients coming in and he was doing a little hybrid model where he would see patients, you know, they’d come in, maybe see the ma, do some checks or whatever, and then he would call them on the phone. So they would come to the office, but he would segregate them and you know, usually have to wait in the car. And then he would do the call on the phone. And if he needed to do an exam in some extenuating situation, he wouldn’t tell him to come back in the office. But you know, he would make sure that he was, everybody was separated and everything. And again, he was just billing insurance, he wasn’t making any extra money.
Michael Staples
And they sent an undercover in who complained of pain every single time, you know, made a thousand excuses and even went and got X rays done and urine drug screens and, you know, things like that. And this was like, you know, probably a 60 year old guy. It wasn’t some young fit person that came in like we used to use when we did undercover investigations. This was somebody that you could look at overweight and say, wow, you know, I bet he does have pain.
Terri Vidals
You know, arthritis when you do your stance.
Michael Staples
And, and this poor doctor actually saw him like three or four visits before he prescribed him anything. And when he did prescribe him something, he prescribed him starting out trim at all. Okay, yeah, you know, and then the guy kept calling back, harassing the doctor, saying, doc, this isn’t working. You know, I, you know, I can’t work. I can’t, you know, I’m having all this extra pain, I need something stronger. And you know, and Doc, you know, say like, listen, you need more time to let the tramadol work. You know, if it doesn’t, you know, if you keep taking it doesn’t work. Then we can discuss something, you know, more.
Michael Staples
So after about a month or so, you know, after constant hounding, I mean, this undercover is calling, constantly hounding this physician, the physician gets on the phone with him and you know, again, he says, this tramadol is not working. So he says, you know, how about you trying some Tylenol threes? And the patient’s like, well, I was really thinking about Norco because my friend is on Norco. And he said it really helps him, you know, and you know, Doc’s like, well, you know, I can do, you know, 5 milligram. It’s not much different than a tie in all three. And he’s giving him like 15 pills you know, like, I mean, it’s just crazy. And, you know, after about two weeks, the guy caught the undercover calls back in wanting to add Gabby’s. You know, he calls them Gabby’s. Yeah.
Michael Staples
And, you know, it’s like, you know, street name for gabapenton. Well, this doctor had no idea what a Gabby was, you know, and even the. The office staff that answered says, I don’t know what you’re talking about. Gabby’s. And he said, gabapentin. Oh, okay. And, you know, the doctor didn’t think anything of it. You know, people called drugs different names and, you know, so he said, well, I want to add Gabby’s. And the doctor said, look, you haven’t done or shown me any reason to. To add gabapentin because you haven’t shown any evidence of radicular pain or any complaints of radicular plain pain. And this guy argued with him and said, doc, I told you from day one you wasn’t. You know, basically, you wasn’t listening. My pain was traveling from my neck to my shoulder to my back.
Michael Staples
You know, I told you that. And he was very adamant on the phone that he told the doctor this. So the doctor said, well, let’s get some more X rays and let’s reevaluate it. And the guy kept pushing and pushing, you know, that he’s having all this pain and all this pain. So the doc gave him the lowest dose of gabapentin again, two weeks worth. Okay. And said, I’ll give you two weeks. Go get the tests, and then we’ll reevaluate it, you know, in two weeks. We’re talking about gabapentin, tramadol, and later a hydrocodone 5. And so after two weeks, when the guy called in for his visit, it was just during COVID times, and because of the documentation, he just automatically refilled the prescriptions. You know, he missed that. You know, so they charge him with drug trafficking in federal court.
Terri Vidals
Wow.
Michael Staples
Yep. And that was actually the case that I testified on about the Snowbird. Snowbird, you know, and now he was exonerated, you know, but it cost him a lot of money.
Terri Vidals
I was gonna say reputation, financial reputation and everything.
Michael Staples
It. I mean, it was just absolutely horrible what. What happened to them. But that was a case where, you know, were the notes fantastic? No, but was he doing anything criminal? Hell, no.
Terri Vidals
And he even tried to.
Michael Staples
Not absolutely. I mean, you know, I’ve never seen where, you know, he kind of followed the escalation, too. Okay. Tramadol’s not working, you know, like, you know, because at first I told him, he told him to take ibuprofen, something, you know, over the counter, which the undercover even complained that he was taking so much his stomach was killing him, you know, which would, again, give more credence to the fact that, okay, he can’t take that anymore because it’s causing adverse effects, so let’s give him a tramadol. But that was the kind of case the government brought, and luckily, the jury, you know, found him not guilty. Great guy, great physician. One of the best, Clint, you know, like, he had a sixth sense for diagnosing people. Like, he could look at somebody and tell what was wrong. I mean, he.
Michael Staples
He found, like, you know, there was patients that he had found that were going to have strokes or massive coronaries that just on, you know, just his sixth sense, he sent them to the hospital and saved their life. There was countless patients like that. Or he uncovered an autoimmune disease that no one was aware of. He just had that sixth sense. He was so dedicated to his field. You know, some people just develop that. That, you know, what I call sixth sense. And. And fantastic physician. You know, just like I said, documentation wasn’t great, but that’s. That’s kind of the example of what, you know, what you’re asking for.
Terri Vidals
Yeah. Wow. Okay. I don’t like to hear that.
Michael Staples
Yeah, it’s. It’s sad, really. It’s. You know, and that’s part of the reason I left the government is because towards the end of my career, were targeting physicians that were not criminals. They just maybe had not dotted an eye or crossed a T. And it got to the point that, you know, I was getting, like, embarrassed and worried. I didn’t want to be in part of that. You know, if they’re criminals, that’s one thing. Let’s lock them up. But, you know, if they’re just, you know, naive physicians or. Or maybe not good at documentation, you know, yes, send them to a CME on controlled substance prescribing, or look at them administratively, but don’t raid their office with a search warrant broad daylight and destroy their career because, you know, they’re a little naive or they, you know, are not documenting.
Terri Vidals
Not to put you on the spot. So maybe you can’t answer it or prefer not to answer. But do you have any. Like, why? I mean, is it just a quota to fill that you have to.
Michael Staples
You know, there’s. There’s a lot of things, you know. You know, there’s the opiate epidemic, you know, which they blame a lot on. But if you look, most of those statistics belong to illicit drugs, and they may have been on opiate medication when they overdose on the illicit drug and then they contribute that, you know, overdose to the prescription drug, but they kind of overlook the illicit drug. So they want to charge the doctor because he has the medication in their system. But really it was a patient that went out and chose to do heroin, you know, that night, you know, when they had no heroin in their system, you know, on any urine drug screens or, you know, no criminal record, nothing.
Michael Staples
You know, I’ve seen physicians charged with that, you know, they try to do that with another physician that we exonerated in Kentucky, and he had about five overdoses, none that, you know, he was even aware of. They. They actually just kept digging until they found patients that are overdose. And even though some of these coroner’s reports listed the number one reason as cardiac arrest, you know, and, you know, so they were using these reports, you know, they had a so called expert medical examiner come in, you know, coroner, and testify that, nope, that’s wrong on that autopsy report. It should have been opiates first and then cardiac arrest, you know, or no, just because he had heroin in the system. That’s wrong, because the opiates know and the benzos contributed to this, you know, overdose and, you know, actually charged the guy and.
Michael Staples
And used those. Didn’t use those deaths as criminal counts, but was able to convince the judge to allow the overdose reports and death records to be used as evidence to show that the doctor was inappropriately prescribing control substances on other counts. I mean, it was a cra. It was the craziest thing. But like I said, you know, again, luckily the jury had common sense and. And saw through it and exonerated, you know, him as well.
Terri Vidals
Okay, well, interesting. Fascinating. Thank you very much for your time, Mike.
Michael Staples
You’re welcome.
Terri Vidals
Yeah. So pharmacists and physicians out there, you heard it. Do your corresponding responsibility, have your checklist, document it and. Because. Yeah, if it’s not documented, it didn’t happen.
Michael Staples
Exactly.
Terri Vidals
Yeah. Okay. All right. Thank you, Mike.
Michael Staples
Thank you, Terri.
