The New Enforcement Environment: How to Keep Your License & Avoid Indictment (1 CME)

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(1 CME) In this conference recording from the 2019 Annual Conference, you will learn:

The Department of Justice, through the formation of twelve “Opioid Fraud And Abuse Detection Units,” has declared “open season” on opioid prescribers under former Attorney General Sessions’ federal criminal enforcement initiative. Relying on FBI, DEA and HHS investigators, and with state medical board and attorney general staff, local U.S. Attorneys’ offices have largely focused on prescribers of Suboxone and other Medically-Assisted Treatments for opioid addiction in their new efforts to detect and prosecute prescribers. Law enforcement now has immediate access to controlled substance prescribing frequency through state-run, online Prescription Drug Monitoring Programs, which allows investigators to quickly target addiction treatment professionals. Many well-meaning physicians have inadvertently become collateral damage in America’s War on Drugs, and are sometimes swept up in criminal prosecution and administrative enforcement initiatives for records violations and for misinterpretation of prescribing regulations and treatment regimens. Arrest and conviction carry severe consequences, including significant monetary fines, loss of medical license, debarment from participation in federal health care benefit programs and private insurance panels, inability to obtain practice insurance coverage and even jail. This crash course teaches practical, “how to” advice for staying on the right side of the law, surviving a law enforcement investigation, and avoiding being targeted by one in the first place.  This course will also address the type of documents and controls physicians should institute within their practices and with their patients, to assure compliance and to address issues related to opioid prescribing, such as interaction with pharmaceutical reps, toxicology programs, prescribing to friends and family and oversight of prescribing and non-prescribing personnel.  It is team taught by a former prosecutor who defends health care providers in enforcement actions and prosecutions under state and federal controlled substance laws, and by a well-known health care lawyer who advises physicians on the day-to-day structuring of compliant pain-management practices.  Between them, they have advised Medication-Assisted Treatment providers, including a large Opioid Treatment (Methadone) Program and Buprenorphine prescribers, and many clinics and office-based practices, concerning the  laws and regulations related to opioids. Avoiding the DEA’s notice isn’t difficult, but it does require knowing the law and regulations for prescribing controlled substances in addiction treatment, and constant attention to operate within them. This 60-minute workshop will cover the essentials: what the law requires, and how to abide by it; what the DEA is looking for, and how to avoid investigation; what to do when the government agents come knocking at your clinic door; responsible office policies and procedures, as well as physician-patient opioid contracts, to promote compliance with laws and rules; and especially, what records to keep and how to keep them, so they are tools for your defense, and not for your prosecution.

Learning Objectives:

1.) Upon completion, participant will know the Drug Enforcement Administration and Health and Human Services (Medicare/Medicaid/private insurer anti-fraud) requirements for lawfully prescribing controlled substances.
2.) Upon completion, participant will be able to understand 'red flag' indicators for diversion and unlawful medical practices, which could lead to loss of state medical license, DEA registration and specialty practice certification.
3.) Upon completion, participant will recognize recent processes and practices which have led to practitioners losing their medical licenses and in some cases even facing federal and state indictment and conviction.

Efrem M. Grail


Efrem M. Grail is a former criminal prosecutor and top-20 law firm partner who established his own firm in Pittsburgh five years ago to defend individuals and entities, most often in health care, facing charges and allegations in white collar criminal matters, administrative enforcement and civil regulatory proceedings, and in related litigation matters. Efrem also advises on legal and regulatory compliance for physicians and provider entities, and conducts internal investigations. He negotiated one for the first (2004-05) civil consent settlements on behalf of a provider with the Drug Enforcement Agency under the Drug Abuse Treatment Act (DATA 2000). He served as outside counsel for Mecication-Assisted Treatment providers including Buprenorphine prescribers and a major urban (Methadone) Opioid Treatment Program, and regularly appears in federal courts nationwide on behalf of accused practitioners, prescribers, clinic owners and pharmacists facing indictment and regulatory charges. He is a member of the Bars of the State of California and the Commonwealth of Pennsylvania, and has been selected "Super Lawyer" in White Collar Criminal Defense. Mr. Grail publishes and speaks on compliance and avoiding criminal and regulatory investigation to physicians, medical providers, and medical and dental students. Efrem received his law degree from Columbia University, after graduating from Northwestern University.

Ericka L. Adler


Ms. Adler concentrates her practice in regulatory and transactional health care law. She represents individual providers, physician groups and other health care entities (i.e. home health care agencies, DME companies, hospices, MRI facilities and surgery centers) in satisfying their day-to-day legal health care needs. Ms. Adler has extensive experience in compliance counselling, structuring and implementing complex joint ventures to comply with state and federal laws and regulations, including Stark, Anti-Kickback Statute, fee-splitting concerns, the corporate practice of medicine and other restrictions on health care professionals. Ms. Adler devotes a large part of her practice to advising professionals and practices on their contracts and compensation arrangements, and in assisting her clients in the acquisition and sale of health care entities. She works with providers in matters relating to HIPAA, fraud and abuse, billing audits, government investigations, licensure matters and contract disputes. In addition, Ms. Adler is a former adjunct professor of law at DePaul University College of Law where she taught a class on healthcare fraud and abuse. She is also a contributing writer to the Law & Malpractice section of the online magazine Physicians Practice, where she addresses legal and management issues facing independent physician practices.
ACCME Accredited with Commendation

ACCME Accreditation Statement

The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement

The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABPM Maintenance of Certification (MOC)

The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

ABAM Transitional Maintenance of Certification (tMOC)

This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

ABIM Maintenance of Certification (MOC)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.


Session Recording
Open to view video.
Open to view video. This session was recorded on 4/6/19 in Orlando, FL
CME Quiz
3 Questions  |  10 attempts  |  2/3 points to pass
3 Questions  |  10 attempts  |  2/3 points to pass Complete the quiz to claim CME.
CME Evaluation
15 Questions
15 Questions Please complete the evaluation to claim CME.
CME Credit and Certificate
Up to 1.00 medical credits available  |  Certificate available
Up to 1.00 medical credits available  |  Certificate available 1 AMA PRA Category 1 Credits