Settlement over prescribing practices puts spotlight on buprenorphine clinics

A chain of buprenorphine treatment clinics agreed late last month to pay $750,000 in a civil settlement for improper prescribing and billing related to the opioid addiction treatment, in a case that speaks to some concerns in the addiction treatment community over the scope of services offered at buprenorphine practices.

Massachusetts-based CleanSlate Centers, which serves more than 6,000 patients a month in several Eastern states, entered into a settlement with the U.S. Attorney's office over allegations that it submitted to pharmacies a number of prescriptions attributed to physicians in cases where only a nurse practitioner or physician assistant saw the patient. These actions allegedly took place from 2012-2014; newly enacted federal regulations now will allow mid-level practitioners to prescribe buprenorphine.

A statement from the U.S. Attorney's office explains that physicians hired by CleanSlate would later backdate the mid-level practitioners' improperly written prescriptions to patient visit dates. Federal officials say the company also repeatedly billed Medicare at physician rates during the period from 2010-2016 in cases when only a nurse practitioner or physician assistant had actually seen the patient, and where no physician was present to supervise the mid-level practitioners.

The statement reads, “The matter was brought as part of the federal response to the growing opioid abuse epidemic in Massachusetts and other New England states. The addictive quality of opioids has contributed to a recent surge in the theft and misuse of prescription pain medications. As a result, federal, state, and local law enforcement and public health authorities are collaborating to support safe prescribing and dispensing of opioid medications.”

A statement last month from CleanSlate CEO Greg Marotta says that the company has fully cooperated with the federal government during the examination of its practices. Marotta added that CleanSlate is working to house a full-time physician at each of its clinic sites, and is also implementing an electronic prescribing system.

Need for comprehensive care

The emergence of buprenorphine as an effective and conveniently delivered treatment for opioid dependence has led to concerns in segments of the addiction field that some clinics are merely handing out medication and offering little to none of the supportive counseling that is seen as a critical component of treatment.

Sylvester “Skip” Sviokla, MD, ABAM, the Rhode Island-based operator of a buprenorphine treatment practice that incorporates on-site counseling services and support, tells Addiction Professional that buprenorphine's ability to offer rapid relief from the fear of withdrawal “allows the prescriber power to insist on immediate engagement with counseling and early frequent drug screens to make plain the need for complete abstinence from any other mind-altering drug.”

Sviokla adds, “Since April 1, eight patients of mine have bought their first home. Each one was between 25 and 40 and used heroin prior to treatment at [Medical Assisted Recovery]. Each has been in medical assisted treatment for two to six years. That screams recovery to me.”

CleanSlate has gained a strong regional reputation in the Northeast in recent years. Its entry into Pennsylvania in 2015 came about as a result of an agreement with Geisinger Health Plan, a commercial and public plan organization with operations in five Eastern states. Health plan executives said at the time that they were particularly impressed with CleanSlate's capacity to work with individuals at all stages along the recovery continuum.