Sessions creates opioid fraud detection unit, focuses on 12 districts

Twelve federal districts have been selected to participate in an Opioid Fraud and Abuse Detection Unit, created by the Department of Justice (DOJ). The DOJ will fund twelve Assistant United States Attorneys for three year terms to focus solely on investigating and prosecuting fraud related to prescription opioids. Attorney General Jeff Sessions announced the program’s formation at the Columbus Police Academy in Ohio.

Data analytics program

The unit will consist of a data analytics program, which will allow targeted investigation and prosecution. Sessions stated that the team would use such information as physicians who prescribe opioids at a higher rate than peers, the average age of patients receiving the prescriptions, and pharmacies dispensing large amounts of opioids to focus its investigation.

The federal prosecutors, located in districts across the country, will work with various agencies to investigate and prosecute opioid fraud, including pill mills and unlawful diversion of opioids. Most of the districts are located in the east and Midwest, such as Florida, Michigan, Alabama, Kentucky, Ohio, and West Virginia.

Prescription fill rates rose for newly insured, especially Medicaid enrollees

New Medicaid enrollees saw the largest increase in prescription fill rates between 2013 and 2014 than any other group, at 13.3 fills on average. Health care transaction tracking showed that the uninsurance rate dropped by 30.4 percent during this time for those filling prescriptions. The results of research, published in Health Affairs, also revealed that program spending for prescriptions increased, and patients spent less out of pocket even as they filled more prescriptions.


The analysis started with health care transaction data for 6.7 million patients that filled prescriptions at retail pharmacy locations in January 2012. Researchers then followed individual patients’ drug transactions, including the uninsured paying cash for prescriptions, until December 2014. This method allowed tracking of health care service use, costs to patients, and costs to payers. Patients were assigned to five coverage categories based on the coverage source that paid for the highest number of prescriptions: Medicare, Medicaid, private, uninsured, or other. Patients were only assigned to the uninsured category when all transactions for the year were paid in cash or through an assistance program, including discount cards.

Coverage changes

Between 2013 and 2014, the uninsurance rate dropped by 30.4 percent among the prescription drug users analyzed. Although the reductions were roughly similar when analyzed by gender and age, females were more likely to gain coverage. States that expanded their Medicaid programs under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) saw a 39.1 percent reduction in the uninsured, while nonexpansion states were at a 22.6 reduction.

Prescription drug spending

Those who were uninsured in 2013 but gained either private or Medicaid coverage in 2014 saw a dramatic increase in prescription drug use. Those transitioning to Medicaid had 79 percent increase in the number of prescriptions filled, while those going to private payers had about a 27 percent increase. As expected, average spending increased with the larger number of prescriptions filled. Average plan or program spending for prescriptions increased by $341 for those who obtained private coverage, while the spending for new Medicaid enrollees went up by $813. Average out-of-pocket spending decreased by $85 and $205 for private and Medicaid coverage, respectively.