Sunday, February 19, 2017

A Comp Fraud Drug Dealer Kills

WorkCompCentral recently reported on sentencing for a Drug Dealer Who Once Defrauded Federal Comp System. The story has several points worth consideration. It has ties to a workers' compensation claim, illustrates issues with workers' compensation fraud, and reminds us of the challenges that opioids cause for our country and its citizens. 

The opioid challenge part is nothing new for readers of this blog, see Maine Makes Opioid Changes, Opioid Guidelines from the CDC, Like a Broken (Drug Death) Record. I think too many people are dying in this country from drug overdose, and have repeated that in many forums. 

The subject of this story, Mr. Christopher Koegl, was a veteran, employed by the U.S. Postal Service. He was entitled to lost wage benefits as a result of a knee injury at work. The U.S. Attorney says that he was also "required to immediately report if he returned to work or obtained new employment," which included self-employment. Reporting on employment is not an uncommon feature of workers' compensation laws that provide for payment of wage-replacement benefits. 

In September 2014, Mr. Koegl was arrested and was charged with "possession of heroin with intent to deliver." He plead guilty to being a drug dealer and was sentenced to 5 years probation. (Red flag #1, heroin dealing = probation?) 

According to the U.S. Attorney's Office, he was also sentenced in March 2016 to probation for making false and fraudulent statements in order to qualify for workers' compensation benefits. Mr. Koegl was indicted for submitting "a false form to the Department of Labor. In it, he attested that "he was not self-employed or involved in any business activities" during the time he was both receiving workers' compensation benefits and running his drug business. (Red flag #2, on probation and committing felony fraud = probation again?)

The felony fraud conviction resulted in cessation of Mr. Koegl's workers' compensation benefit entitlement, and he was ordered to pay over $31,000 back to the government. A drug dealing workers' compensation fraud was caught and convicted. The penalty is to pay back the money, years of probation and no more workers' compensation. If the penalty for stealing $31,000 is paying back $31,000, will that deter people from stealing?

But as noted above, Mr. Koegl made it back in the news recently due to yet another conviction. According to WorkCompCentral, Mr. Koegl was running a "full-fledged operation" in 2014. When he was arrested for dealing drugs, he had "more than 20 grams of heroin, cash, a digital scale, pay/owe sheets and, in the trash, 65 tin foil squares containing black tar heroin residue." And, Mr. Koegl had a three-person sales force assisting him with marketing his product. But, he was sentenced to probation.

How did it all start? Mr. Koegl told investigators that he suffered a knee injury in 2010. One source reported that he also had a "military injury" at some point and that he was prescribed opioids for that condition. For some reason, Mr. Koegl was later unable to "get opioids" for his complaints and he therefore turned to heroin. At some point, he became addicted to heroin, and then became a drug dealer to support that habit. 

Alexander Herdt, a customer, somehow came in contact with one of Mr. Koegl's salespeople and purchased heroin. In 2014, Mr. Herdt fatally overdosed. Cellphone records led authorities to connect Mr. Herdt, the three salesmen, and Mr. Koegl. All four were indicted for "conspiracy to distribute heroin," but Mr. Koegl was also charged with "distributing heroin resulting in death." If convicted of that, Mr. Koegl faced "a minimum 20-year sentence." His recent plea bargain avoided that. 

The described circumstances involve elements that individually are unfortunately not uncommon today. Medication dependence exists. Some people are eventually denied access to prescription opioids. Evidence supports that some of those people turn to non-prescribed (street) opioids, or other substances. People are dying in America. We know all of this is true. 

I am reminded of Ross Perot's presidential bid eons ago. When describing the national debt (then about $4 trillion), he said it "is like a crazy aunt we keep down in the basement. All the neighbors know she's there, but nobody wants to talk about her." Is the American drug death pandemic any different? We all know she's down there. Why is this not being talked about? It is definitely more important than the latest escapades of the Kardashians, the Bieber, or the donut-licking pop star, but somehow it rarely makes the headlines. 

How did we get here? An article by National Public Radio (NPR) reminds us that perspectives on pain changed in the 1980s. Doctor's beliefs about pain coincided with "more available prescription painkillers." The result was increased prescriptions and increased addiction. Thirty years after the pandemic started, NPR says that "in 2011, the Centers for Disease Control and Prevention declared a prescription drug epidemic as a result of doctors over-prescribing painkillers." Mr. Koegl is thus certainly not alone in his use of opioids. This NPR article is a "must read" to understand how America got where it is regarding prescription pain medication. 

When I was young (yes, I was young once), heroin was in the news periodically. There were populations that frequented that drug and there were overdoses. However, the news of that is seemingly more prevalent today. And, some believe the medical community and its love affair with opioids is to blame. The National Institute on Drug Abuse concluded that "the incidence of heroin initiation was 19 times higher among those who reported prior nonmedical pain reliever use." Note that "nonmedical" use is "characterized by three main sources of opioids: family, friends, or personal prescriptions." In any event, those opioids were prescribed by a physician. 

The Partnership for Drug-Free Kids reports that "people addicted to opioid painkillers are 40 times more likely to abuse or be dependent on heroin." And heroin is definitely cheaper than non-medical opioids. The Partnership for Drug-Free Kids reports that OxyContin "sold on the street is $50 to $80 per pill, while generic oxycodone sells for $12 to $40 per pill." The Washington Post reported that a dose of heroin is cheaper, in some states, than a pack of cigarettes (we tax the cigarettes). 

The downward path is relatively simple. A patient is prescribed narcotics, and through health insurance or workers' compensation, or other programs is provided with that medication at minimal personal financial expense. It is easy to get and cheal to use. They become addicted to, or dependent upon, the substance and crave the feelings and relief that it brings. Then, whatever system has thus introduced this person to the drugs abandons them. High and dry, they have choices. Unfortunately, many are choosing to continue using drugs, but now without that prescription. And the economic choice seems pretty simple to calculate, $12 for an oxycodone or "about $5" for heroin. 

People are dying, and Dying to me don't sound like all that much fun. Overdose is touching thousands of lives, of the users, and those around them. I know I sound Like a Broken Record

The fraud in Mr. Koegl's case cheated the workers' compensation system and he was slapped on the wrist. He was convicted of drug dealing and was slapped on the wrist again. And, now that someone has died, Mr. Koegl is going to prison, where he unlikely to pay back the $31,000 he stole from workers' compensation. 

Perhaps as a society we should be more concerned about prescribing opioids to begin with. Are there viable alternatives instead of opioids; can we at least discuss that question? When they are prescribed, perhaps we should be more concerned that there is care and intelligence in the course of later discontinuation of those drugs. And, perhaps there are better answers to curbing the inclination of so many to both use and abuse drugs. People are dying, and I am just not convinced that we care about this "crazy aunt" we just don't want to talk about.  

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