Data analytics companies are growing in the business market.  It has become quite competitive.  One thing I’ve noticed about the two main companies focusing on heath records and data is that they are registered as 501 (c)(3) nonprofits.  I personally don’t see how they qualify as a non-profit, as their goal is to make money.

Appriss and it’s NARxCHECK was discussed in Part 2.  This post will be about Qlarant. Qlarant uses data analytics to go through practitioner records to detect possible fraud, waste and abuse (FWA) for the government. The plan is to gather information necessary to maximize the DEA’s law enforcement efforts. They point this out on their website.

In 2018, more than 600 practitioners in 58 federal districts were charged with participating in fraud schemes which the government claimed involved  about $2 billion in Medicare/Medicaid.

Opioid use in 2017 shows that

• Nearly 1 in 3 Part D beneficiaries received at least 1 prescription opioid
• 76 million opioid prescriptions were paid for by Part D
• 10% of Part D beneficiaries received opioids for more than 3 months.
• Almost 460,000 Part D beneficiaries received high amounts of opioids.
• About 71,000 beneficiaries are at serious risk of opioid misuse or overdose
• 300 prescribers had questionable opioid prescribing patterns for those 71,000 beneficiaries.

As a result of the 2017 takedown, 587 health care providers were excluded from Medicare/Medicaid as a result of convictions of health care fraud, patient abuse or neglect, or illegal activity tied to opioids.

In 2018,

• 48,558 beneficiaries were considered to be at serious risk of opioid misuse or overdose
• 40,374 beneficiaries received extreme amounts of opioids (>240 MME for 12 months)
• 8,796 beneficiaries were doctor shopping or pharmacy hopping

Beneficiaries supposedly at risk for opioid misuse or overdose per their data analytics:

2916	89,843
2917	71,260
2018	48,558

 

Prescribers identified as having questionable opioid prescribing:

2016	401
2017	282
2018	198

 

Qlarant analyses provider prescribing with the intent to highlight aberrant behavior and indicate the likelihood of diversion.  The analytics includes:

• The number of CII prescriptions
• Pill counts
• The distance a patient drives
• The number of prescriptions written per month.
• Instances of distributor “crew chief” schemes
• Pre-seizure identification of the most likely drug-seeking patients
  • Minority Report Now a Reality
  • Pre-Crime
  • Hypothetical Targeting of Crimes
• Other customized selections.

Qlarant is a company working for the United States Attorney’s Office to identify and target prescribers as it

“allows law enforcement to more effectively leverage their resources to address the worst offenders.”

The types of analytics and data searched for include prescriptions

• Over 90 morphine mg equivalents per day
  • From multiple prescribers during a given period
  • Disproportionate use of opioids with high street market value, e.g. methadone, OxyContin® et al.
  • Both benzodiazepines and opioids concurrently
  • Narcotics requiring long-distance travel to obtain
  • Concurrent use of opioids and opioid potentiators

They get this information from the state PDMP’s. As they are not practitioners or pharmacists, how do they get access to our private healthcare records?  IMO, this is an invasion of our 4^th amendment rights. I guess once the USAO gets the data, they can give it to whomever they want for analysis.

Then Qlarant helps in the coordination with the DOJ for conviction of practitioners.  This involves the development of the case itself, organizing and preparing data to support search warrants, arrests, and convictions.

Qlarant has a case study on their website of how they helped convict a doctor based on the mme’s prescribed, and the use of Subsys off-label, neither of which are criminal acts. But with Qlarant’s help, the doctor was convicted.

Another targeting method is The Prescription Behavior Surveillance System (PBSS) run by Brandeis University.  It began in 2012 with support from the CDC and FDA, and is administered through the BJA (Bureau of Justice Assistance).

Just think of all of your tax dollars being used to do these data analyses in the attempt to stem drug addiction, when drugs aren’t even the cause of addiction. And please realize that doctors aren’t targeted because they are doing anything wrong. They are targeted by methods simply designed to target somebody, to satisfy job security.