Arizona lawsuit opens window into lucrative drug rehab business — and allegations of fraud

https://www.azcentral.com/story/money/business/health/2017/12/04/arizona-lawsuit-health-net-drug-rehab-business-fraud/907734001/

The only “Obamacare” health insurer in metro Phoenix and Pima County is ensnared in a legal dispute with several addiction treatment centers over the cost of care amid an Arizona opioid epidemic that is taking an average of two lives each day. 

Nine alcohol and drug rehabilitation centers claim in a Maricopa County Superior Court lawsuit that the health insurance company Health Net of Arizona improperly withheld or delayed lucrative payments for treatment of people struggling with addiction.

But Health Net says in a counterclaim that there was widespread fraud among Arizona and California drug rehab centers in 2015 and 2016, when it alleges”teams of brokers” recruited out-of-state clients to fraudulently obtain insurance policies and to seek treatment in Arizona.

Those actions have cost the insurance company — and Arizona consumers through higher monthly premiums — tens of millions of dollars, the Health Net counterclaim says.

The lawsuit reveals the financial engine of a booming rehab industry that has fed the growth of facilities aiming to get and keep people off alcohol and drugs such as opioids and heroin.

The growth of rehab centers corresponds with the rise of residential “sober homes” that have sprouted in upscale neighborhoods of Phoenix, Paradise Valley, Scottsdale and other communities in metro Phoenix. 

MORE: ‘What to know about ‘Obamacare’ sign-ups

The proliferation of these homes pits residential neighbors against rehab entrepreneurs in standoffs that have created headaches for local government officials as they try to determine how to manage the unregulated industry. 

Prescott, which once claimed more than 100 sober homes, has adopted regulations to provide more oversight of them.

The sober homes provide a safe haven for people trying to overcome drug or alcohol addictions. These homes generally do not provide treatment, but people living in them often seek outpatient treatment from affiliated rehabilitation clinics.

Arizona’s rehabilitation industry has caught the attention of regulators in other states. 

The Massachusetts attorney general this year warned consumers to be wary of solicitations to enter rehab in Arizona, Florida and California. Federal and state prosecutors have aggressively pursued cases in Florida and California in connection with fraudulent activities such as patient brokering.

There have been no criminal cases filed in Arizona, however. 

Six of the rehab facilities that accuse Health Net of improperly withholding payments are in Prescott: Chapter 5 Counseling, Prescott House, Compass Recovery Center, Clean Adventures of Sober Living, Decision Point Center and Carleton Recovery Centers.

Three others, T R U Recovery Solutions, North Ridge Counseling and Desert Cove Recovery, list Scottsdale addresses. 

The rehab facilities allege that Health Net improperly withheld payments to virtually every rehab center in Arizona and southern California beginning in January 2016. Health Net halted the payments as part of an investigative audit that demanded each center provide detailed records such as proof of patients’ residency and assurances that patients did not receive incentives to sign up for rehab. 

MORE: Did Arizonans see 116 percent increase in ‘Obamacare’ premiums?

Health Net did not resume making payments until May 2016, the lawsuit states. By then, the rehab centers were financially squeezed and even had to turn away Health Net-insured clients. 

“We’ve had treatment centers that have had to close their doors due the lack of payments,” said John Flynn, a Phoenix attorney who represents Arizona and California rehab facilities in separate lawsuits filed in each state. “Patients were sent away because they could not (afford to) address their needs.”

The Arizona lawsuit also claims that Health Net issued inaccurate financial statements in late 2015 and early 2016 because it did not report an estimated $150 million in claim payments owed to the rehab centers. Health Net was acquired by St. Louis-based Centene Corp., which later restated the financial statements to reflect the claim payments, the lawsuit stated.

A California lawsuit filed by multiple rehab businesses, including Shreya Health of Arizona and Sovereign Health of Arizona, claims Health Net refused to pay $55 million in medically necessary services. Shreya Health and Sovereign Health both have facilities in Chandler.

Soaring claims

Health Net said in court documents that claims filed by rehab centers in Arizona soared because of widespread fraud. Health Net representatives, citing ongoing litigation, would not discuss the case with The Arizona Republic.

However, Health Net said in a counterclaim that the fraud involved Health Net’s “preferred provider,” or PPO, plans that paid benefits to rehab centers that were not part of the insurer’s network.

In-network providers typically agree to offer services at negotiated discounted rates, and consumers typically pay less out of pocket for in-network claims. But consumers typically have to pay a larger share of the bill from out-of-network providers, which are not obligated to charge negotiated, discounted rates.

Health Net’s PPO plans paid $2.4 million to all Arizona rehab centers in 2014. Those payments soared to $47.4 million in 2015. Those plans paid more for rehab care that year than all other types of care in Arizona, including typically expensive medical care such as cancer, heart disease and child births, according to the insurer’s counterclaim.

Those higher insurance costs, which Health Net alleges resulted from fraud, are collectively paid by all customers in the form of higher premiums, the insurer said in court filings.

The nine centers that Health Net sued in its counterclaim had collectively billed the insurer $28 million from January 2015 through September 2016, the lawsuit stated.

Here’s how the fraud worked, the insurer said in its counterclaim:

• Brokers would scout out people in 12-step programs, Alcoholics Anonymous meetings, homeless shelters and jails, then refer these clients to the “highest-bidding clinic.”
• Clinics that were not part of the insurer’s network paid clients’ insurance premiums and out-of-pocket costs such as deductibles and co-payments.
• The result was that people secured Health Net coverage “arranged and bought for them by financially-interested providers for one purpose only: to obtain coverage for the limited time needed to rack up millions of dollars in substance abuse treatment.” 
• Some clinics misrepresented the home addresses of patients, many of whom lived out of state. 

Health Net said that the Arizona centers, and others, engaged in “a sophisticated fraud involving the fraudulent enrollment of non-Arizona residents,” who signed up for Arizona insurance policies. 

Even though “many, if not most” prospective clients lived out of state, they were signed up for Health Net PPO plans for Arizona residents, often misrepresenting their home address on applications, according to the counterclaim.

The insurer described examples of two New York residents enrolled in a Health Net plan and encouraged to get treatment at Clean Adventures of Sober Living in Prescott.

One New York patient, identified as M.B., reportedly told a Health Net investigator that a Clean Adventures staff member told him to list the rehab facility’s address on his insurance application.

A second New York patient, identified as J.S., told an investigator a Clean Adventures staffer put him in contact with an insurance agent who suggested using Clean Adventures’ address on his insurance application, the counterclaim stated. 

The insurer named 10 other examples of people who lived in California, Indiana, New Jersey, New York, Tennessee and Wisconsin but represented that they lived in Prescott or Scottsdale. The insurer did not identify which rehab centers those individuals used, but said they were among the nine rehab centers in the counterclaim.

Health Net said that the treatment centers often purchased and paid for the insurance policies but did not disclose this to patients, who were often told they were eligible for a “scholarship program” that covered rehab costs.

The insurer also said the rehab centers engaged in fraudulent billing, charging for services that were not medically necessary or in amounts that exceeded what the plan allowed. 

Health Net said the centers inflated the bills so they could collect from the insurer costs that should have been paid by consumers, such as co-payments and coinsurance.

READ MORE: Arizona declares opioid crisis a public-health emergency

The counterclaim also says the nine Arizona centers billed Health Net less than $56,000 in January 2015. However, during a one-year period through July 2016, those substance-abuse facilities billed Health Net more than $12.5 million.

The counterclaim asks the court to award damages in an amount to be proven at trial and to order the centers to cease engaging in those business practices. 

The rehab centers deny any wrongdoing in an answer to the counterclaim.

Flynn noted that the case is in discovery. He said his team has yet to receive all documentation requested from Health Net, including documents supporting allegations listed in the counterclaim.

Confluence of laws

Arizona rehab industry officials said it appears a small number of rehab centers took financial advantage of a confluence of federal laws. 

A 2008 law called the Mental Health Parity and Addiction Act requires insurance plans to provide equitable coverage for substance abuse and addiction treatment. The Affordable Care Act also requires health insurance plans cover essential health benefits, including behavioral health services, and it forbids insurers from denying coverage to individuals based on existing medical conditions. 

“The unintended consequence was (some) addiction treatments centers began taking advantage of that and over-billing,” said Angie Geren, executive director of Addiction Haven, a grassroots and advocacy organization focusing on addiction issues. 

Geren said that while the vast majority of Arizona centers have not engaged in such activity, the state’s reputation has been harmed by the actions of those that did.

Massachusetts Attorney General Maura Healy earlier this year warned that her office received reports of individuals trying to recruit people to “so-called treatment centers in Arizona, California or Florida.”

Healy warned residents to be wary of addiction-treatment centers that arrange out-of-state travel or offer to cover insurance payments. Individuals who arrange for addiction treatment may be getting payments from the rehab centers they are recruiting for. 

Massachusetts has a law that prohibits the receipt of payments or kickbacks for referring a patient to treatment.

Arizona Rep. Noel Campbell, R-Prescott, earlier this year introduced House Bill 2333 that sought to curb the practice of paying referral fees to brokers who steer patients to rehab centers.

Under Campbell’s bill, referrals of more than $1,000 would have triggered a Class 3 felony charge with a possible penalty of 3.5 years in prison. However, the bill never made it out of committee.

Florida has enacted “patient-brokering” laws aimed at eliminating such activity at rehab homes there. Prosecutors also have aggressively pursued criminal charges.

Dave Aronberg, the state attorney for Palm Beach County, Fla., said law enforcement there has arrested 41 individuals. The most common charge involved violation of the state’s patient-brokering law, he said 

“The scam starts with deceptive advertising at the beginning,” Aronberg said. “You are lured down to sunny Florida with a free plane ticket, which is illegal. You are given illegal benefits to keep you there.”

But Aronberg said patients often find themselves booted from treatment when their insurance benefits run out. That creates an incentive for people to relapse so they can obtain another round of coverage.

Aronberg’s office has started a Sober Home Task Force targeting the practice of buying and selling patients battling addiction. His office also has received leads and information about similar activity in other states, including Arizona and California, particularly Orange County. 

Alan Johnson, a Palm Beach County chief assistant state attorney who oversees the county’s sober-home task force, said sober homes have sprouted in communities there. These homes provide out-of-state patients a place to live while they undergo drug treatment.

A key funding source for the rehab centers, which often work in tandem with sober homes, has been urinalysis testing. These tests, for which the centers charged large and repetitive fees, proved lucrative from 2014 through 2016. However, insurers are beginning to scrutinize payments for such tests more closely.

Johnson said rehab centers that provide legitimate services are being harmed as insurance companies scrutinize payments and bad actors poach patients away. 

“There’s less gravy in the gravy train,” Johnson said. 

Reach the reporter at ken.alltucker@arizonarepublic.com or 602-444-8285.

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Could Marijuana Replace Opioids As A Painkiller? Experts Are Skeptical

https://www.forbes.com/sites/michelatindera/2017/12/03/could-marijuana-replace-opioids-as-a-painkiller-experts-are-skeptical/#1477810f6209

The heavy marketing and widespread access to opioid pills sparked a national crisis that’s now labeled a “public health emergency” by the U.S. government. Last year, some 60,000 Americans died of drug (including opioid) overdoses—that’s some 12,000 more than traffic-related deaths in the same year. As physicians look for new, less harmful, ways to manage their patients’ pain, could medical marijuana be the answer–or the makings of another public health crisis?  

That question was asked by an audience member at the Forbes Healthcare Summit in New York on Thursday. The idea drew immediate skepticism from Tom Frieden, who headed the Centers for Disease Control and Prevention under President Obama and now heads a non-profit, Resolve to Save Lives.

 “The huge problem with legalization is that in the current legal context of the U.S., if you legalize a product you cannot restrict its market, and what we’re looking at is the prospect of having Big Tobacco paralleled by Big Marijuana actively promoting marijuana use,” Frieden said. “It could be very harmful for some people and some communities. That said, there may be a role for some individuals, and obviously this is a tough issue.”

Wilson Compton, the deputy director at the National Institute on Drug Abuse, said that the National Institutes of Health is trying to support more rigorous research on medical marijuana. He said the studies out there today tend to be small and disparate with the different types of pain conditions that are looked into. “While it looks like there’s a general signal, we don’t know who the marijuana, or the cannabinoids within the plant, might be useful for,” Compton said. “And that’s where I think research needs to move.”

Medical marijuana is now legal in 29 states and the District of Columbia, and as that number continues to grow, more drug companies are looking for ways to use the plant and its potent cannabinoids to relieve pain. Several companies like publicly-traded GW Pharmaceuticals and Cara Therapeutics are developing drugs using these properties but none have been approved by the Food and Drug Administration yet.

But Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University and a critic of opioid overuse, said that at least marijuana would be better than opioids

 “If I had a patient who was suffering from severe intractable pain and had tried everything, I would sooner try marijuana on a patient than heroin,”

Kolodny said. “When you are prescribing opioids, you are essentially giving them heroin.”  

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The Feds Are Sticking It To Chronic Pain Patients

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N.J. opioid prescriptions were among lowest in U.S. before Christie’s tough new law

http://www.nj.com/politics/index.ssf/2017/05/nj_tied_for_the_lowest_rate_of_opioid_prescription.html

TRENTON — New Jersey last year reported one the lowest opioid prescription rates in the nation, even before Gov. Chris Christie signed into law tough new restrictions limiting when doctors may prescribe potentially addictive pain killers, according to a new survey. 

In New Jersey, prescriptions declined from 5.16 million to 4.59 million, a decline of 11 percent, according to a report released by the American Medical Association.

That amounts to 0.5 prescriptions per capita, second-lowest behind California and Hawaii at 0.4 scripts. New Jersey is tied with Alaska, Massachusetts, Minnesota and New York, according to the report released Friday.

In its report, “Physicians’ progress to reverse nation’s opioid epidemic,” the leading lobby for doctors said prescribing rates have declined in all 50 states. During the same period of time, physician use of state prescription drug monitoring programs and the number of physicians undertaking training programs on opioid prescribing, pain management, addiction have spiked dramatically.

Opioids over-prescribed in South, but not much in N.J.

“These are good signs of progress, but to truly reverse the nation’s opioid epidemic, we all have much more work to do,” said Patrice A. Harris, who chairs the AMA’s Board of Trustees. 

Despite its dense population and ample access to physicians, New Jersey has ranked low in opioid prescription rates for some time. In 2012, the U.S. Centers for Disease Control and Prevention found 63 prescriptions were written for every 100 people New Jersey, at the bottom with New York, Minnesota, California and Hawaii in the lowest group.

Alabama and Tennessee were the highest-prescribing states, recording 143 prescriptions per capita, the CDC found in 2012. 

Last year, the CDC set guidelines for prescribers which state a seven-day supply is typically all that is required. In February in a show of determination to combat an epidemic of overdoses, Gov. Chris Christie and the Legislature adopted a law setting a five-day initial prescription that a doctor could increase after four days if pain has not subsided.

The Medical Society of New Jersey, the state affiliate for the American Medical Association, opposed the bill and predicted  cautious doctors would be reluctant to recommend opioids when they are necessary. 

Mishael Azam, chief operating officer for the Medical Society, said that prediction has come true, based on conversations with its members.

“Since the CDC guidelines were released and (S3) was signed, patients feel like criminals for needing pain medication,” Azam said.

“Patients who need medication for mobility or daily quality of life are losing access because physicians are being blamed for opioid addiction, thus reducing even legitimate prescribing,” Azam said. “Physicians are in fact learning and changing behavior, doing their best to balance the goals of treating patients and reducing addiction.”

Christie has made reducing the addiction and overdose rate of heroin and prescription drugs the centerpiece of his final year in office.

Backed by CDC studies and statistics that have shown a corresponding rise in the number of opioid prescriptions and fatal overdoses, Christie has taken aim at prescribing practices in the state and expanded the requirements that pharmacists update and doctors consult the statewide prescription monitoring database.

The law says doctors treating patients for acute pain must limit the length of the initial prescription to no more than five days. The law allows physicians to add another five days to the prescription after the fourth day if the pain has not subsided.

The measure would not apply to hospice or cancer patients or people in long-term care facilities, according to the bill. Nor would it apply to patients who are being treated for chronic pain.

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Meth-related overdose deaths hit record number in WV

https://www.wvgazettemail.com/news/health/meth-related-overdose-deaths-hit-record-number-in-wv/article_67cb7c01-fba3-5dbc-80c8-f9913e07dfde.html

Overdose deaths related to methamphetamine in West Virginia have increased by 500 percent in just four years, according to new data released by the state Health Statistics Center.

A record-number 129 people have died from meth-related overdoses this year — and that number is expected to increase significantly as the state catches up on counting fatal overdoses.

About half of the meth overdoses involve fentanyl, a powerful synthetic opioid that remains the leading cause of drug overdoses in West Virginia. Addicts are using meth laced with fentanyl, sometimes unknowingly, said Chad Napier, prevention officer with the Appalachian High Intensity Drug Trafficking Area.

“A lot of these people don’t know what they’re getting,” Napier said. “We’re seeing the meth cut with fentanyl, so that’s increasing the meth [overdose] numbers, I believe.”

Kanawha and Cabell counties have been hardest hit by meth-related overdoses. Thirty Kanawha residents have died from meth overdoses this year, 28 in Cabell. Raleigh and Wood counties had the next-highest number of fatal meth-related overdoses with eight each.

Statewide, meth-related overdose deaths have increased each of the past four years — from 21 in 2014, 49 in 2015, 107 in 2016 and 129 deaths so far this year.

Police agencies are seizing an increasing amount of crystal meth made in Mexico by drug cartels and distributed in Appalachia through Atlanta; Columbus, Ohio; and Detroit, Napier said.

Several years ago, meth dealers and users across the state were making the drug in small, clandestine “shake-and-bake” labs, but the number of those labs has declined significantly as crystal meth from Mexico has become the preferred choice among users.

Dr. Rahul Gupta, state health commissioner, said drug users also are mixing meth and heroin. The Mexican-made meth inundated the southwestern United States before spreading east.

“We’re seeing a lot more meth, and it’s a different kind of meth than we were seeing five or six years ago,” Gupta said. “There’s a push from the cartels to get these drugs out there.”

Doctors sometimes prescribe methamphetamine, sold under the Desoxyn brand, to treat people with attention-deficit disorder. But the state Board of Pharmacy has found no meth-related overdoses linked to prescription methamphetamine.

“The stats reflect illicit meth,” said Mike Goff, an administrator at the pharmacy board. “[Overdoses caused by] street drugs are all up.”

For instance, there’s been a resurgence of cocaine abuse in the region, Napier said, along with a corresponding increase in cocaine-related overdose deaths.

In West Virginia, cocaine deaths jumped from 57 in 2014 to 157 in 2016, and 126 cocaine-related fatal overdoses have been reported this year with many more to be counted. Cabell County leads the state with 31 cocaine-related overdose deaths this year.

Dealers also are lacing cocaine with fentanyl, Napier said, though he didn’t know the percentage of cocaine-related deaths that also involved fentanyl.

Not long ago, it was uncommon for meth addicts to abuse opioids or for heroin or pain-pill addicts to use meth. That’s changed during the past two years.

“They’re mixing stimulants with depressants,” Napier said.

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CVS looks to expand health clinics with Aetna deal

http://www.theledger.com/news/20171201/cvs-looks-to-expand-health-clinics-with-aetna-deal

NEW YORK — CVS Health Corp is planning to significantly expand health services at its retail pharmacies if it completes a more than $66 billion deal for insurer Aetna Inc , a move that could save more than $1 billion annually, people familiar with the matter said.

A key rationale is to use many of the U.S. pharmacy chain’s 9,700 brick-and-mortar outlets to improve access to preventative care and cut back on some emergency room visits for Aetna’s roughly 23 million members with medical coverage, these people said.

The full benefits of the strategy will take several years to realize, requiring billions of dollars in investment to increase the number of CVS clinics and provide the staff and equipment for a wider variety of treatments, the people said.

Those funds would be diverted from planned investments in CVS retail facilities, and not amount to additional expenses, they said.

Deal talks between the companies are still underway, and an agreement could be announced as early as Sunday or Monday, sources familiar with the matter told Reuters. It is also possible that a deal is delayed or does not materialize, they said.

Health insurers have redoubled their efforts to cut costs in a time of steep prescription drug price rises and requirements to care for even the sickest patients under the Affordable Care Act.

Aetna last year tried to buy rival Humana Inc to gain more leverage over costs, but that transaction, as well as a proposed merger between Anthem Inc and Cigna Corp , was shot down by antitrust regulators.

Many insurers have already been encouraging patients to use urgent care centers, which can provide some of the same services as emergency rooms for as little as a tenth of the cost, said Laurel Stoimenoff, chief executive of the Urgent Care Association of America.

Minuteclinics

The industry has grown to about 8,000 urgent care centers nationwide, as more hospitals, insurers and private operators open such walk-in facilities, Stoimenoff said, with 400 to 500 centers added each year. They may be staffed by doctors and provide relatively advanced care including X-rays.

 CVS operates more than 1,000 MinuteClinics, which offer more basic services ranging from flu shots to physicals and are mainly staffed by nurse practitioners.

Combined with Aetna, the company would be able to seamlessly access medical records, offer certain preventive services to covered members for free and make drugs promptly available in adjacent CVS pharmacies, said Dan Mendelson, president of consultancy Avalere Health.

The in-store clinics could provide immunizations, check if a patient needs antibiotics, help manage chronic illnesses like diabetes or even administer medications by infusion, but are unlikely to offer acute treatment of serious injuries, healthcare experts said.

“It would probably be unsettling to people coming in to buy socks to have someone with a bleeding head come in for stitches,” said Greg Burke of the United Hospital Fund, a non-profit focused on improving healthcare in New York.

Expanding the clinics could eventually save the combined company more than $1 billion annually by substituting low-cost treatments in CVS stores for more expensive hospital visits, two people familiar with the matter said. The combined net income of Aetna and CVS is forecast to be about $9.25 billion in 2017, according to Thomson Reuters data.

Aetna competitor UnitedHealth Group Inc operates 230 MedExpress urgent care centers in 17 states in one of its fastest-growing divisions, with nearly 20 percent compounded revenue growth per year.

For CVS, which has seen non-pharmacy sales decline at its stores, the clinics could have the added benefit of bringing in new customers and providing alternatives for less productive retail space.

“It’s a tough retail environment. I think they’re going to devote less space to it and more to different healthcare services and clinics,” said Jeff Jonas, a portfolio manager at Gabelli Funds which owns shares in Aetna and CVS.

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How opioids started killing Americans at the corner pharmacy

http://www.sentinelsource.com/how-opioids-started-killing-americans-at-the-corner-pharmacy/article_4e393039-7b4d-5de4-b435-4c09930101dd.html

It’s been conventional wisdom for some time now that America’s opioid epidemic began at the pharmacy. Now there are numbers to put any doubt to rest.

More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died. Only 4 percent were ever diagnosed as having an abuse problem, said Mark Olfson, one of five researchers who conducted a massive study of the crisis and its causes for Columbia University Medical Center.

The findings of the new study, published Tuesday in the American Journal of Psychiatry, split the epidemic into two groups: those who were diagnosed with chronic pain and those who weren’t. In the year before they died, about two-thirds of those studied were diagnosed with chronic pain and prescribed an opioid. (Many would also get a prescription for anti-anxiety drugs called benzodiazepines, which can make for a deadly combination.) The other third among those who died had no diagnosed chronic pain but became addicted to opioids in another way.

“Those are different populations,” Olfson said in a telephone interview. “Understanding those things puts us in a better position to combat the epidemic.”

According to the National Institute on Drug Abuse, more than 33,000 Americans died from opioid overdoses in 2015. Most of those deaths were linked to prescription pain pills, though the use of heroin was already growing rapidly, accounting for almost 13,000 fatalities that year. The scourge has continued to inundate America’s health care infrastructure. An analysis published this week by OM1 Inc., a company that uses artificial intelligence to improve health outcomes,

found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related.

And while opioid prescriptions have become harder to come by, the drugs are still too easy to obtain, U.S. health officials have said. The amount of opioid painkillers prescribed in the U.S. peaked in 2010 and declined each year through 2015, according to the Centers for Disease Control. Nevertheless, the drugs are prescribed about three times as much as they were in 1999, the CDC said in July.

Olfson said he hoped the study would alert lawmakers and health care providers to those at highest risk, as well as the dangers of prescribing opioids and benzodiazepines simultaneously.

Each piece of data, he said, helps give people a sense of the “crisis we’re in the midst of.”

“found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related”

The article was about OPIATE OD’s… ED visits that could include “opiate related”.. would be someone in pain- or addicted – seeking a prescriptions for a opiate...

10 Most Common Reasons for an ER Visit

Most of the TOP TEN REASONS for a person to go to an emergency room is for direct/indirect issues that would involved PAIN..

The “crisis” that we are in.. seems to be more build out of FABRICATED DATA !… it is more like a “magic act” than reality..

 

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