Would the theft of fentanyl intended for pain management of multiple patients, and replacing it with saline solution, result in a false claim if the medication were submitted for reimbursement? [F602 Free from Misappropriation/Exploitation; F609 Reporting of Reasonable Suspicion of a Crime; F697 Pain Management; F759 Free of Medication Error Rates of 5% or more; and F760 Residents Are Free of Significant Med Errors]
Compliance Perspective – Tampering
Policies/Procedures: The Compliance and Ethics Officer, DON and Administrator will review the policies and procedures regarding the facility’s system for storing and accounting for all controlled medications, the precautions in place for safe administration of medications and the protocol to use when drug diversion and tampering are suspected.
Training: Staff will be trained about the risk to residents of drug diversion, and the process involved with maintaining security of narcotics on each shift and justifying the narcotic count when shift changes occur.
Audit: An audit will be conducted weekly to ensure that the protocol for justifying the narcotics count is performed correctly with the on-coming nurse (not the off-going nurse) reviewing the physical count with the written record. The Audit will verify that packets and medication containers have not been tampered with and that the dispensation of the medication has been documented. Results of the audits will be submitted to the QAPI/QAA Committee and the Compliance Committee. NOTE: If errors are discovered, a supervisor must be notified immediately.
A nurse, Donald Friedlich Mills, III, was recently sentenced to five years of probation with six months of in-home confinement after pleading guilty in May 2017 to tampering with consumer products and to acquiring fentanyl by misrepresentation, fraud, forgery and deception. Fentanyl is a highly addictive and dangerous synthetic opioid pain reliever.
The clinic where Mills was employed notified the Federal Drug Enforcement Administration (DEA) that it had lost 200 ml of fentanyl due to employee pilferage in March 2017. After being advised of his rights, Mills was interviewed by the DEA. He told investigators that he had been self-medicating his neck pain and anxiety with injections of patients’ fentanyl that he would replace with saline solution. He claimed that if the patient was his, he made sure that they got a full vial along with whatever he had switched.
The DEA took into evidence 22 packages of fentanyl suspected of having been tampered with. Tests of 15 of those packages revealed that no fentanyl remained inside them. Also included in the evidence were syringes and vials labeled as saline.
In a sentencing memo, the Assistant U.S. Attorney said Mills could have taken the fentanyl without replacing it with saline, but that would have led to the tampering being discovered sooner. “The defendant chose to be deceptive and replace the fentanyl with saline water in order to continue to have access to the drug, knowing the risk it would pose to patients,” the U.S. Attorney said.
