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https://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=148

“Entrance to a coal mine in West Virginia. September 1908. By Lewis Hine ”
Mining doesn’t bring prosperity to most, though some of the coal miners were comparatively well-paid in more recent times: https://en.wikipedia.org/wiki/Sixteen_Tons https://youtube.com/watch?v=MTCen9-RELM Nonetheless, it’s environmentally damaging and is unsustainable.

Although this ARPO Strike Force takedown is billed as Appalachia, this horrible case occurred outside of Appalachia: “In the Western District of Tennessee, 15 individuals were charged, involving eight doctors and several other medical professionals.  In one case, a nurse practitioner who branded himself the “Rock Doc,” allegedly prescribed powerful and dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors; over approximately three years, the doctor allegedly prescribed approximately 500,000 hydrocodone pills, 300,000 oxycodone pills, 1,500 fentanyl patches, and more than 600,000 benzodiazepine pills.” (Excerpt from DOJ News release, found further below.)  Louisiana is also included, and it is certainly not Appalachia. Appalachian poverty has been a well-known issue since at least the 1960s, and probably since the 1930s, or even before. Rather than trying to lift these people up out of poverty, the US government decided to import increasing numbers of immigrants in the 1960s, to further suppress the value of the US labor force. While percentage poverty has declined in Appalachia, it would be interesting to know if the actual numbers of people impoverished have declined. Our guess is that the actual numbers of people impoverished have remained the same or increased. Presumably the 53 medical professionals arrested are part of the affluent classes.

There are lots of poor, struggling Americans, but it’s not politically correct to be worried about them. Only new immigrants matter to the political class, churches, and mainstream news. They see them as future voters and church members and to hell with the rest of us. The Republicans and Democrats want more and more immigrants and show no concern about the impact on those who already live in the United States, and who have no other country to return home to. It’s not just illegal immigrants that suppress wages, but legal ones too, due to sheer quantity. When there are too many people, life itself loses value. With more people, even the value of one’s vote is diluted. If there were any political will or love of country, a socially and environmentally sustainable economy could be planned and built. But, there is none.

Additional victims of the opioid crisis are those who are in real, physical, pain and are unable to get pain killers, possibly due to diversion of the drugs to addicts; possibly because legitimate doctors fear prescribing them. Those who can’t get effective allergy medicine anymore are victims of the Meth epidemic, as well. Because of abuse, those with legitimate needs have trouble getting the drugs that they need.

“The Appalachian Region

The Appalachian Region, as defined in ARC’s authorizing legislation, is a 205,000-square-mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi. It includes all of West Virginia and parts of 12 other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Forty-two percent of the Region’s population is rural, compared with 20 percent of the national population.

The Appalachian Region’s economy, once highly dependent on mining, forestry, agriculture, chemical industries, and heavy industry, has become more diversified in recent times, and now includes manufacturing and professional service industries. Appalachia has come a long way in the past five decades: its poverty rate, 31 percent in 1960, was 16.7 percent over the 2012-2016 period. The number of high-poverty counties in the Region (those with poverty rates more than 1.5 times the U.S. average) declined from 295 in 1960 to 93 over the 2012-2016 period.

These gains have transformed the Region from one of widespread poverty to one of economic contrasts: some communities have successfully diversified their economies, while others still require basic infrastructure such as roads and water and sewer systems. The contrasts are not surprising in light of the Region’s size and diversity. The Region includes 420 counties in 13 states. It extends more than 1,000 miles, from southern New York to northeastern Mississippi, and is home to more than 25 million people. 

Counties in Appalachia https://www.arc.gov/appalachian_region/CountiesinAppalachia.asp
Regional Data https://www.arc.gov/research/DataReports.asp
Maps https://www.arc.gov/research/MapsofAppalachia.asp
Research Reports https://www.arc.gov/research/ResearchReports.asp
Economic Status of Appalachian Counties
County Economic Status and Distressed Areas in Appalachia
https://www.arc.gov/appalachian_region/CountyEconomicStatusandDistressedAreasinAppalachia.asp
County Economic Status Definitions
https://www.arc.gov/research/SourceandMethodologyCountyEconomicStatusFY2007FY2018.asp
Economic Status, by County, Fiscal Year 2019 (Map)
https://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=148
Economic Status, by County, Fiscal Year 2018 (Map)
https://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=137
List of Economically Distressed Counties in Appalachia, FY 2019
https://www.arc.gov/program_areas/ARCDesignatedDistressedCountiesFiscalYear2019.asp
List of Economically Distressed Counties in Appalachia, FY 2018
https://www.arc.gov/program_areas/ARCDesignatedDistressedCountiesFiscalYear2018.asp
https://www.arc.gov/appalachian_region/theappalachianregion.asp

While not in Appalachian, the Mississippi Delta is highly impoverished too. Bobby Gentry’s “Ode to Billy Joe” should set the tone for this story: https://youtu.be/nv33eaygVDQ

It’s shameful to have to Trump’s obstructionist AG Barr, who comes from an affluent NYC background, pretending to care about these poor rural folks, when we know he doesn’t give a rats ass about them (or the rest of the country for that matter). Thus, the following excerpts do not include his comments on the matter, though they may be seen at the link.
“FOR IMMEDIATE RELEASE
Wednesday, April 17, 2019
Appalachian Regional Prescription Opioid (ARPO) Strike Force Takedown Results in Charges Against 60 Individuals, Including 53 Medical Professionals
Charges Involve Over 350 Thousand Prescriptions for Controlled Substances and Over 32 Million Pills; ARPO Strike Force Grows to 10 Districts, Expanding to Include the Western District of Virginia…

“The charges announced today involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a priority for the Department.  According to the CDC, approximately 130 Americans die every day of an opioid overdose.  

“Today’s takedown demonstrates the FBI’s unwavering commitment to working alongside our Strike Force partners, including the HHS-OIG and DEA, to fight the opioid epidemic and related criminal activity in the Appalachian region,” said FBI Executive Assistant Director Hess. “We will not stand by and allow the harmful and oftentimes deadly practice of over-prescribing highly addictive drugs to continue unchecked. The FBI will pursue medical personnel who misuse their positions of trust to blatantly disregard others’ very lives for their own financial gain.”

“The opioid crisis has had a devastating impact in the Appalachian region,” said Principal Deputy Inspector General Chiedi. “Addressing this public health issue and ensuring beneficiaries have continuity of care requires a collaborative approach with our federal, state, and local partners. Our commitment is resolute. We will continue working together to protect the health and well-being of all Americans and ending this terrible epidemic.”

“Opioid misuse and abuse is an insidious epidemic, created in large part, by the over-prescribing of potent opioids nationwide, and unfortunately, Appalachia is at the center,” said DEA Assistant Administrator Martin.  “Today’s announcement sends a clear message that investigations involving diversion of prescription drugs have been, and continue to be, a priority for DEA.”

“CMS CPI is proud to work very closely everyday with our law enforcement partners to stop the exploitation of vulnerable patients and misuse of taxpayer dollars,” said Deputy Administrator and Director of Center for Program Integrity Alexander.

“Nowhere is this collaboration more important than in our fight against the opioid crisis in America. This is one of the President’s highest priorities and we are proud to be an important part of the largest prescription opioid enforcement effort ever undertaken. We will continue to work tirelessly through investigation, data coordination and administrative action to protect the health and wellbeing of all Americans.”

The ARPO Strike Force is made up of prosecutors and data analysts with the HCF Unit, prosecutors with the 10 U.S. Attorney’s Offices in the region, including the newly added Western District of Virginia, and special agents with the FBI, HHS-OIG and DEA.  The ARPO Strike Force operates out of two hubs based in the Cincinnati, Ohio/Northern Kentucky and Nashville, Tennessee, areas, supporting the 10 districts that make up the ARPO Strike Force region.  In addition, the APRO Strike Force works closely with other state and federal law enforcement agencies, including the Tennessee Bureau of Investigation, State Medicaid Fraud Control Units. 
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For the ARPO Strike force locations, in the Southern District of Ohio, six individuals, including two doctors and three registered pharmacists were charged with several counts, including unlawful distribution of controlled substances and conspiracy to obtain controlled substances by fraud.  In one case, a doctor who is alleged to have been at one time the highest prescriber of controlled substances in the state, and several pharmacists are charged with operating an alleged “pill mill” in Dayton, Ohio.  According to the indictment, between October 2015 and October 2017 alone, the pharmacy allegedly dispensed over 1.75 million pills.  These cases were brought with assistance from the FBI, DEA, and HHS-OIG, as well as the Ohio Attorney General’s Office, Medicaid Fraud Control Unit; the Ohio Bureau of Workers’ Compensation Ohio; the Ohio Board of Pharmacy and the Ohio Medical Board.

In the Western District of Kentucky, a doctor was charged with controlled substance and health care fraud counts in connection with providing pre-signed, blank prescriptions to office staff who then used them to prescribe controlled substances when he was out of the office, and for directing staff at the clinic, including individuals not licensed to practice medicine, to perform medical services on patients.  In another case, a doctor, a Florida compounding pharmacy and its owner were charged in connection with a scheme that involved the payment of alleged kickbacks in return for writing prescriptions for compounded drugs that included controlled substances, and for fraudulently inflating the costs for prescriptions that were billed for reimbursement by Medicare and TRICARE.  These cases were brought with assistance from the FBI, DEA, HHS-OIG, and the Defense Criminal Investigative Service, as well as the Kentucky State Police, the Louisville Metropolitan Police Department, the Kentucky Office of Inspector General, the Kentucky Department of Insurance, and the Kentucky Medicaid Fraud Control Unit.

In the Eastern District of Kentucky, a total of five people were charged, including three doctors, a dentist and an office assistant who were charged in connection with several health care fraud and/or controlled substance schemes.  In one case a doctor operating a clinic that focused on pain management allegedly provided pre-signed, blank prescriptions to office staff who then used them to prescribe controlled substances when he was out of the office.  In another case, a solo practitioner who operates a five-clinic family practice focusing on pain management allegedly billed Medicare for urine testing that was not done and for urine testing that was not medically necessary.  A dentist was charged for alleged conduct that included writing prescriptions for opioids that had no legitimate medical purpose and that were outside the usual course of professional practice, removing teeth unnecessarily, scheduling unnecessary follow-up appointments, and billing inappropriately for services.  In yet another case, a doctor was charged for allegedly prescribing opioids to Facebook friends who would come to his home to pick up prescriptions, and for signing prescriptions for other persons based on messenger requests to his office manager, who then allegedly delivered the signed prescriptions in exchange for cash. These cases were brought with assistance from the FBI, DEA, HHS-OIG, and the Kentucky Medicaid Fraud Control Unit.

In the Middle District of Tennessee, federal indictments were unsealed today charging nine Middle Tennessee medical professionals, including four doctors, four nurse practitioners and a pharmacist, with various charges alleging their participation in illegally prescribing and dispensing opioids and other dangerous narcotics and health care fraud schemes.  Two cases involve doctors who were previously sanctioned by the Tennessee Medical Board in connection with the overprescribing of opioids, one of whom was sanctioned for providing prescriptions to vulnerable patients, while the other allegedly prescribed opioid pills after serving a Board imposed term of probation.  Another case alleges that a doctor prescribed opioids and other controlled substances to at least four individuals.  In another case, an advanced practice registered nurse at a pain management clinic allegedly wrote prescriptions for opioids that had no legitimate medical purpose and that were outside the usual course of professional practice.  Separately, a pharmacist was charged for allegedly dispensing large amounts of opioids outside the usual scope of professional practice and for no legitimate medical purpose.  Finally, a podiatrist was charged with unlawful distribution of controlled substances.  In addition to assistance provided by the FBI, DEA, and HHS-OIG, these cases were brought in connection with assistance from the Tennessee Bureau of Investigation, Medicaid Fraud Control Unit; the 18th Judicial District Drug Task Force; the Sumner County District Attorney’s Office; and the District Attorney General for the 22nd Judicial District.

In the Eastern District of Tennessee, at total of eight individuals, including five doctors, a nurse practitioner, a physician’s assistant, and an office manager were charged in four cases.  Four doctors, a nurse practitioner and a physician’s assistant were charged with the unlawful distribution of opioids.  Two doctors were charged with health care fraud violations.  Three of these cases are related to alleged pill mill operations in the Eastern District of Tennessee. In addition to assistance provided by the FBI, DEA, and HHS-OIG, these cases were brought in connection with assistance from the Tennessee Bureau of Investigation, Medicaid Fraud Control Unit.

In the Western District of Tennessee, 15 individuals were charged, involving eight doctors and several other medical professionals.  In one case, a nurse practitioner who branded himself the “Rock Doc,” allegedly prescribed powerful and dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors; over approximately three years, the doctor allegedly prescribed approximately 500,000 hydrocodone pills, 300,000 oxycodone pills, 1,500 fentanyl patches, and more than 600,000 benzodiazepine pills.  In another case, a nurse practitioner charged with conspiracy to unlawfully distribute controlled substances allegedly prescribed over  500,000 Hydrocodone pills, approximately 300,000 Oxycodone pills, and approximately 300,000 benzodiazepine pills (mostly Alprazolam), along with a myriad of other controlled substances.  In another case, a physician charged with controlled substances and health care fraud violations allegedly prescribed approximately 300,000 hydrocodone pills, 200,000 oxycodone pills, 2,500 fentanyl patches, and 180,000 benzodiazepine pills, and prescribed medically unnecessary durable medical equipment that was billed to Medicare.  Another doctor charged with controlled substances violations allegedly prescribed approximately 4.2 million opioid pills, sometimes in dangerous combinations with other drugs, such as benzodiazepines, and prescribed opioids to known addicts.  In addition to assistance provided by the FBI, DEA, and HHS-OIG, these cases were brought in connection with assistance from the Tennessee Bureau of Investigation, Medicaid Fraud Control Unit, the Tennessee Office of Inspector General, and the West Tennessee Drug Task Force (28th District).

In the Northern District of Alabama, multiple individuals were charged in five cases, including four doctors.  In one case, the owners and operators of a medical clinic and dispensary were charged with the unlawful distribution of controlled substances and health care fraud.  In that case, a doctor allegedly prescribed opioids in high dosages, dangerous combinations, and in many cases, after having knowledge that patients failed drug screens and were addicts, preferring cash payments and charging a “concierge fee” that ranged from approximately $50 per visit or $600 per year.  In another case, a doctor allegedly recruited prostitutes and other young women with whom he had sexual relationships to become patients at his clinic, while simultaneously allowing them and their associates to abuse illicit drugs at his house.  In yet another case, a doctor allegedly dispensed controlled substances and other prescription drugs directly from the clinic, and prescribed excessive quantities of controlled substances to the same patients several times per month resulting in as many as 15 pills per day for some patients.  In that case, the doctor also signed blank prescription forms to be completed by her staff when she was not at the clinic. 

In addition to assistance provided by the FBI, DEA, HHS-OIG, the Defense Criminal Investigative Service and the Food and Drug Administration, Office of Criminal Investigations, these cases were brought in connection with assistance from the Hoover Police Department, the Huntsville Police Department, the Huntsville Area HIDTA Drug Task Force Strategic Counter Drug Team, the Marshall County Drug Task Force, the Alabama Medicaid Fraud Control Unit, and the Madison County Sheriff’s Office. 

In the Northern District of West Virginia, a case was brought against an orthopedic surgeon who allegedly used fraudulent prescriptions to obtain tablets of acetaminophen-codeine for his own use. To obtain the pills, the surgeon allegedly wrote out prescriptions using his DEA number, and in the names of a relative even though the pills were for his own use, using a driver’s license that he had stolen from a colleague to obtain the pills from pharmacy.  This case was brought in connection with assistance from the DEA and HHS-OIG.

In the Southern District of West Virginia, a doctor was charged with allegedly distributing narcotics, including dextroamphetamine, methylphenidate, and amphetamine salt, to a patient who did not have a medical need for the drugs and whom the doctor never examined. This case was brought in connection with assistance from the DEA and HHS-OIG.
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In addition to the ARPO Strike Force districts, today’s enforcement actions include cases brought in the Eastern District of Pennsylvania and the Eastern District of Louisiana. 

In the Eastern District of Louisiana, a neurologist at an alleged pill mill was charged with conspiracy to dispense controlled substances and conspiracy to commit health care fraud.  The defendant allegedly pre-signed prescriptions for controlled substances, including oxycodone, for patients whom he did not personally examine to determine medical necessity for the prescriptions, and pre-signed prescriptions for controlled substances while he was travelling internationally.  The defendant allegedly knew that certain of these patients used their Medicare Part D and Medicaid benefits to pay for the medically unnecessary prescriptions. In addition to assistance provided by the FBI, DEA, HHS-OIG, these cases were brought in connection with assistance from the U.S. Departments of Veterans Affairs – Office of Investigations.

In the Eastern District of Pennsylvania, a former licensed practical nurse allegedly filled fraudulent prescriptions for oxycodone in her name and in the names of others at a local pharmacy in order to obtain the pills for herself and to distribute to others. In addition to assistance provided by the FBI, DEA, HHS-OIG, the Office of Personnel Management, the U.S. Marshalls Service, these cases were brought in connection with assistance from the Caln Township Police.
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For any patients impacted by the law enforcement operations, DOJ, DEA, HHS-OIG, HHS’ Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, and all five State Departments of Health are deploying federal and state-level strategies to address patient harm and insure continuity of care.  Additional information regarding available treatment programs and where patients can turn for assistance is available as follows:
Alabama: The Alabama Department of Mental Health has a dedicated telephone number to connect those affected by the closure. The toll-free substance abuse number is 1-844-307-1760.   Information about substance abuse and opioids is available at the following websites:
http://www.alabamapublichealth.gov/pharmacy/opioid-and-heroin.html

Understanding the Opioid Crisis


Kentucky: If you are in Kentucky and are suffering with addiction you can find help by calling 833-8KY-HELP or logging in at Findhelpnowky.org
Ohio: If you are seeking help in Ohio, please call the OhioMHAS patient helpline, at 1-877-275-6364
Tennessee: If you are seeking help in Tennessee:
* For a referral to addiction treatment services, call the Tennessee REDLINE: 800-889-9789.
 
* In a mental health crisis, call the Statewide Crisis Line: 855-CRISIS-1 (855-274-7471).
 
* For help accessing substance abuse or mental health services call the Tennessee Department of Mental Health and Substance Abuse Services Helpline: 800-560-5767 or 615-532-6700.  This line is staffed Monday-Friday, 8 a.m. – 4:30 p.m. CT.
 
West Virginia: If you are in West Virginia and are suffering with addiction you can find help by calling 1-844-HELP-4WVor logging in at https://HelpandHopeWV.org
For individuals seeking help in other states, please call 1-800-662-HELP
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  The Medicare Fraud Strike Force, including the ARPO Strike Force, has charged more than 200 individuals with opioid-related crimes.
If you, a family member, friend or loved one believe you may be a victim in any of these cases or in connection with any charged defendant, please visit the following website for additional information:
https://www.justice.gov/criminal-vns/case/ARPO
Additional documents related to this announcement are available here:
https://www.justice.gov/opa/documents-and-resources-april-17-2019-press-conference
https://www.justice.gov/opa/pr/appalachian-regional-prescription-opioid-arpo-strike-force-takedown-results-charges-against

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