Doctors booted from Medicaid for massive oxy doses in Florida Palm Beach Post Staff Writer

The state’s most prolific prescriber of Medicaid-financed oxycodone to the poor in 2010

and 2011 has been barred from participating in the taxpayer supported health care program,

one of 76 such high-volume prescribers identified in a Palm Beach Post investigation.

Four others, including West Palm physician Dr. John Christensen, are either under

regulatory scrutiny or have been disciplined for their prescribing patterns.

None wrote more oxycodone prescriptions than Dr. Jorge Leal. The Tampa-area

anesthesiologist and pain clinic specialist prescribed over 715,000 doses of oxycodone

billed to Medicaid over two years – on average, just under 1,000 doses a day. On busy

days, Leal’s oxycodone scripts were filled by the bushel: Multiple times, more than 2,000

pills a day were filled by pharmacies and billed to Medicaid; during one 24-hour period,

that number topped 4,000 pills.

Seven people in Florida die each day from prescription drugs, a 2009 study found; oxycodone

killed the most.

Despite state law enforcement’s all-out war on oxycodone abuse, however, Medicaid paid for

more than 49 million doses of the powerful narcotic oxycodone over a two year period, The

Post found. Only 1.3 million adults are enrolled in Medicaid.

The majority of those doses were in the form of oxycodone pills not mixed with aspirin or

another drug. While effective for relieving severe pain, including pain from cancer, such

“undiluted” oxycodone is also favored by addicts.

Leal said through a lawyer that his two pain clinics were among a diminishing number still

willing to treat Medicaid patients, which may have accounted for the higher oxycodone

dosage figures. “In this area, Medicaid only has one provider in Pinellas County for pain

management, no provider is listed for Pasco County, and only two provider groups are listed

in Hillsborough County,” pointed out attorney Jon Pellett.

Asked about the decision to drop Leal from Medicaid, a spokeswoman with Florida’s Agency

for Health Care Administration said that the state could cut off a physician from the

program with 30 days notice without providing specific reasons.

In addition to Leal, another physician, Dr. Harold Laski of Jacksonville, has had his

Medicaid privileges revoked. Laski, who could not be reached for comment, wrote

prescriptions totaling 105,189 doses of oxycodone.

Among the other Florida doctors who wrote Medicaid-funded oxycodone prescriptions topping

100,000 doses in 2010 and 2011:

— Partly citing overprescribing, the state Board of Medicine last month revoked Dr. John

Christensen’s medical license. The West Palm Beach physician prescribed 148,367 doses of

oxycodone billed to Medicaid in 2010 and 2011.

— Dr. William Crumbley, who prescribed 173,699 doses of oxycodone, a figure that

translates to about 260 pills a day, rejected a settlement offer from the Board of Medicine

permanently restricting him from prescribing certain narcotics, including oxycodone, as

well as barring the Tampa-area physician from affiliating with any pain management clinic

in Florida. Crumbley was arrested late last year on charges of operating a pain clinic

without a license. He was subseqently charged with bringing drugs into jail. He has entered

a plea of not guilty.

— St. Petersburg internist Dr. Fadi Saba is being monitored by the state’s Bureau of

Medicaid Program Integrity. Saba prescribed a total 110,000 doses of oxycodone billed to

Medicaid in 2010 and 2011.

Monitoring, said an ACHA spokeswoman, “means that there is an open case on that provider

or (the state) is monitoring prescribing reports to determine if further investigation is

warranted.”

The monitoring information was included in a letter sent earlier this year by state health

officials to U.S. Sen. Charles Grassley. The Iowa Republican has asked states to identify

and give him the status of high volume prescribers of certain psychiatric medicines and

pain killers billed to Medicaid, including oxycodone.

In serious cases following monitoring, the doctor can be kicked out of the Medicaid

program.

That has not always worked out as planned. For instance, Dr. Robert Reppy of Tampa,a high-

volume prescriber, was terminated from the Medicaid program on Feb. 24, 2011.

But beginning the next day and continuing for months afterwards, the doctor’s oxycodone

prescriptions were still being filled at pharmacies, state-provided data shows. In all,

16,305 doses of oxycodone prescribed after he was ousted from Medicaid were billed to the

health care program.

“We are reviewing the prescriptions for the time period Dr. Reppy was inadvertently

allowed to prescribe to verify they were medically necessary,” confirmed another ACHA

spokeswo