It always starts with a phone call.
An unassuming but authoritative presence on the phone, usually an investigating officer from a local police station requesting to speak with a healthcare provider regarding a particular patient. The receptionist normally answers the phone.
She instantly grasps the magnitude of it, tepidly walks over to the provider and blankly indicates a law enforcement agent is on the line – prompting the provider to stop whatever he or she is doing and answer the phone.
It’s never a good idea to keep law enforcement waiting on the line.
The conversation is terse. The officer on the line mentions the patient in question and inquires about the care received. Questions center on specific actions that transpired during the patient encounter:
“Did you even see the patient?”
“Did you conduct a physical exam?”
“Do you have the medical records?”
“When was the last time you ordered a drug screen?”
They soon focus on the main question on the mind of the officer – the controlled substance prescribed.
“Do you know how many pills you prescribed?”
“How many did you prescribe last time?”
For many in the healthcare world, the word choice and the emphasis on the number of prescription medications seem odd. Most don’t think of medications as pills, or focus on the total number of medications prescribed as opposed to what the daily use of medications would be.
The exchange highlights a growing shift in how investigating officers investigate healthcare providers. Previously, law enforcement looked for signs of a potential drug exchange – medications for something. They would identify specific acts or behaviors as criminal.
Now, if a provider doesn’t perform a specific act, such as ordering enough urine drug screens, then that provider is a suspect. The underlying assumption is that the lack of oversight makes up potentially criminal behavior.
This transforms an investigative phone call into something far more speculative. It makes sense to investigate a provider for exchanging medications for cash, sexual favors, or other illicit gains. But to investigate a provider for not doing something is an entirely different matter.
It would be akin to pulling someone over for speeding just for driving a sports car. You can assume that if someone drives a sports car, they may likely speed in the future. But there’s no factual basis for it.
Yet this is how many DEA investigations begin. A local officer reaches out to a provider, usually based on a tip from a nearby pharmacist, and initiates a phone call based upon that tip. Ostensibly to ask about a patient that was seen, but really to identify incongruences between what the provider says and what information the officer has received.
If the provider cannot recall the number of prescription pills given to the patient in question, the officer may assume that the provider is being careless with the prescriptions and notify the DEA.
If the provider acknowledges that a urine drug screen was not performed at the last visit, the officer may assume the provider is not providing the proper oversight to prevent diversion.
Law enforcement has prioritized the risk of diversion over the clinical care of a patient, the potential risk over the actual risk. This means that what does not happen in the clinical encounter is now as important as what actually happens during the clinical encounter.
Ultimately, the objective is to identify specific acts, or the absence of specific acts to justify the need for further investigation – regardless of whether that justification is based on wide-ranging, inconsistent interpretations.
It all begins with a call, which makes these phone exchanges even more critical. The decision to investigate a provider, conduct a raid of his or her clinic, and seize medical records derives from these initial interactions.
After the call, the investigating officer determines whether the provider warrants further examination, and if so, reaches out to a regional DEA office. Most DEA branches are understaffed and rely heavily on local law enforcement. So if the local officer believes a provider should be investigated, then the DEA usually follows that lead.
DEA agents will then find a patient, pharmacist, or even a neighboring tenant to serve as an informant against the provider. Anything that at the very least insinuates improper behavior.
This entails having the informant complete an affidavit, a written statement confirmed by oath or affirmation, for use as evidence in court to secure a search warrant in federal court. The affidavit is given to a local magistrate federal judge, someone appointed by the court to assist the publicly elected district judges. Magistrate judges oversee initial appearances of criminal defendants, set bail, and conduct other administrative duties. Their role is procedural.
Once they receive an affidavit, they often authorize a search warrant with little to no oversight on the authenticity of the document or even question why that informant was chosen to speak against the provider. The decision to provide a search warrant is reflexive.
Once the search warrant is granted, the DEA prepares for their famed drug raids. These consist of local law enforcement and DEA agents bursting into provider offices with guns drawn and bulletproof vests festooned as though they are entering active combat. The act is ceremonial, intended to intimidate and humiliate providers and the patients who are present.
While performing their raids, DEA agents scour about, not actually doing much of anything, as the actual investigative work comprises little more than uploading or photocopying a few medical records.
But that’s not the point. The effect of the investigation is more important than the act of investigating itself. This is what happens when you place the speculative risk of drug diversion over the actual risk of providing poor patient care.
It all comes down to that initial phone call. It’s the anatomy of every DEA investigation.