Is Your Organization Safe From a Cyber Attack?

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cyber security, digital footprint, Facebook, firewall, HIPAA, Linked in, security and internal controls, Twitter

By Michael Geis, Vice President of Information Services, CISM, CISSP, myMatrixx

We are starting to see a shift in the cyber security world in the way that organizations are being targeted. Gone are the days of the “hacker” in some dark basement somewhere trying different tactics to gain control of corporate firewalls and databases. Well, to be fair, these days aren’t long gone as those types of attacks are still out there. But the bad guys are adapting faster than the good guys can keep up. While organizations race to make sure they are staying HIPAA/PCI/SOX/ISO compliant the bad guys have figured out we are still working off a playbook that has been around for 10+ years. Why “hack” when you can target specific individuals with access to the resources you want and just ask them for it? The latest battleground is individually targeted attacks or “spear-phishing” and there isn’t much that being HIPAA compliant is going to do to protect you when the bad guys set their sights on your employees.

It seems that all of the latest high-profile breaches started with internal employees clicking a poisoned link in an email or inadvertently disclosing confidential information to attackers. With this in mind we recently did an organization wide IT security awareness training class for all myMatrixx employees. The training was targeted at three primary topics

• Understanding this new threat landscape: who is doing it and why
• How does it work: step by step examples of how an individual is targeted and exploited
• Awareness of personal digital footprints

After the training, the recurring theme in the feedback we got from our employees was:  fear and concern. To be honest most employees in the American workforce haven’t heard this message before. The idea that a specific employee might be directly targeted and the bad guys are armed with an incredible amount of personal data (freely provided by that digital footprint) about that employee is at least slightly disconcerting the first time you hear about it.

We completed the presentation with tips on how to protect yourself from this new type of attack.  Here are some examples:

• Know your personal digital footprint: Facebook, Twitter, Linked in, state and local governmental databases, press releases, Instagram, Spokeo, old online resumes, etc.
• Understand the persuasion levers of using authority, nostalgia, verifiable facts, or appeal to emotions in trying to extract information that you normally wouldn’t share with a stranger
• If you get an email request that is suspect…pick up the phone and call the person asking for the information and verify its legitimacy
• Don’t use the same password across multiple sites on the internet!
• Wait until you get back from vacation to put those pictures on Facebook
• Be aware that EVERYONE is a potential target (IT folks make fantastic targets!)

These types of attacks will continue to grow in frequency and sophistication. Why?  Because they work! The strongest defense for this type of attack for the foreseeable future is turning your employees into human firewalls to protect your organizations critical data. This can only be done with training and awareness and you probably aren’t delivering it if you haven’t updated your security awareness curriculum in the past 12 months.

Join Our Team

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Ancillary Services, pharmacy, Workers' Compensation

myMatrixx is growing and now seeking talented individuals for several positions. Join a dynamic organization focused on providing pharmacy benefits and ancillary medical services for workers’ compensation programs. Headquartered in Tampa our company culture is centered around our core values:

• Do the Right Thing
• Respond with Care
• Serve with Passion
• Innovate Constantly
• Love to Learn

myMatrixx has been recognized for 5 consecutive years as one of the fastest growing companies in Tampa on the Tampa Bay Business Journal Fast 50, has ranked on the Inc. 5000 list for three years in a row, has been awarded the Excellence in Service Award by the Tampa Bay Technology Forum and awarded the IT Dream Team Award by the Tampa Bay Business Journal to name a few.

If you’re seeking a challenging position with an exciting organization dedicated to exceptional customer service, then myMatrixx is the place for you.

Please send your resume for consideration to careers@mymatrixx.com.

Sales and Marketing Project Specialist

We are looking for an individual who is organized, action-oriented, strong project management skills with excellent verbal and written communication skills. Must have solid Salesforce.com and Excel experience.

Programmer I

We are looking for an individual with Java/J2EE web apps experience. Must have a strong knowledge of query design and optimization using SQL. Ability to create and maintain technical design documents. Solid in computer science programming languages, database theory, & operating systems. Must be organized, action-oriented, strong project management, and excellent verbal and written communication skills. BS degree and 3 – 5 experience.

Project Analyst

We are looking for solid SQL and financial analyst experience. Must be organized, action-oriented, have excellent project management skills, as well as outstanding verbal and written communication skills.

Ancillary Customer Service Representative

We are looking for a customer focused individual who is organized with excellent verbal and written communication skills to join our Ancillary Medical Services & DME team.

Customer Service Representative

We are looking for a customer focused individual who is organized with excellent verbal and written communication to join our Customer Service Department.

Provider Administrator

Position will work with the Ancillary Medical Services & DME team to conduct provider training, credentialing and maintaining documents for all active providers. Must be customer focused, organized with excellent verbal and written communication skills.

Provider Relations Representative

Position will work with the Ancillary Medical Services & DME team and respond to inquires from providers and negotiate contract terms and pricing. Must be customer focused, organized and have excellent verbal and written communication skills.

Receptionist

Must be customer focused, organized and have excellent verbal and written communication skills.

Which Opioid is the Worst Opioid?

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Clinical, FDA, Opana, Opioid, pharmacy, Phil Walls, prescription drugs, Workers' Compensation

by Phil Walls, R.Ph., Chief Clinical and Compliance Officer

MSNBC recently published an article entitled “Rural America finds new killer in drug Opana®”. The article indicates that “Opana is the hot new prescription drug of abuse, sometimes with tragic consequences.” It has been pointed out in numerous articles and presentations that deaths associated with prescription drug abuse now outnumber those from heroin and cocaine combined. This is all too true in rural America, and attention is being focused on Opana. Opana contains the ingredient oxymorphone. Opana ER replaced OxyContin® as the choice for abuse for one simple reason – Purdue Pharma, which manufactures OxyContin, released a re-formulated OxyContin last year which makes it more difficult to chew or crush than the original version. This re-formulation was a direct result of the FDA’s Risk Evaluation and Mitigation Strategy. Chewing or crushing is what enables the drug abuser to experience the euphoria associated with ingesting or injecting a high dose of an opioid. The good news, if there is any in an article of this nature, is that REMS also applies to Opana ER. As a result, the old version of Opana ER is no longer being produced as of late last year. In fact, the only Opana product available from the myMatrixx mail service pharmacy is the new version which is similar to the re-formulated OxyContin in that it is difficult to chew or crush. So what happens if both OxyContin and Opana ER have been re-formulated?

Several consequences may result: 1) the sales of Oxycontin and Opana ER should decrease if they no longer provide a convenient source of high dose opioid for intentional abuse, 2) the drug abuser may seek out heroin or other illicit substances, 2) the drug abuser may find alternatives to their prescription drug of choice, or 3) the drug abuser may find ways to bypass the new formulations of OxyContin or Opana ER. Unfortunately the internet has turned into a resource for drug abusers that fall into the latter category.

I heard Opana described as much more dangerous than OxyContin recently (largely I believe because of the article referenced by MSNBC), and that made me question whether or not one opioid may be more dangerous than another. In my opinion, here are my conclusions on this question:

• All opioids are dangerous.

• The euphoria created by opioids is dose dependent, which means that an addict may get “high” from an injection of heroin or from intentionally consuming large quantities of an over the counter opioid such as dextromethorphan. Yes, I just said over-the counter opioid.

• It is true that one opioid may be more “potent” than another. However, dose (or the amount consumed which is dependent on access) is more important that potency when it comes to abuse.

• The real danger in terms of side effects such as respiratory depression and death lies in drug characteristics other than potency. This includes the long biological half-life (the amount of time it takes for the body to eliminate half of the drug) of a drug like methadone, or the ability to by-pass a drug’s “extended-release” formulation. The latter has included crushing or chewing drugs like OxyContin or Opana ER (although the new formulations make this more difficult) or the intentional misuse of Duragesic® or fentanyl patches. The latter I have heard described as “fentanyl tea” in which the patch is “brewed” as in the making of a cup of tea. I am also aware of emergency room incidents in which the abuser has severe burns caused by the application of a hot iron to the patch in order to cause rapid release of the fentanyl.

With all that said, I repeat, all opioids are dangerous. I wish there was a simple solution where I could recommend that certain opioids should simply be blocked from your formulary. However, there are steps that can be taken to minimize risk:

1. Monitor early use of opioids through our ARM program,
2. Consider the use of step-therapy in the approval of opioids,
3. Adopt patient-provider agreements (aka, narcotics contracts) as policy for the use of any opioid,
4. Monitor the daily morphine equivalent dose through our myRisk Predictor™.

If I have to name one opioid as “most dangerous”, then it would be methadone because of its relatively short duration of analgesic effect and long biological half life. This combination makes it very easy for a patient or drug abuser to inadvertently suffer an overdose and possibly death.

 

Concerned about the growing opioid crisis? So are we.

Tags

Clinical, Opioid, Phil Walls, prescription drugs, Steve MacDonald, Workers' Compensation

By Steven MacDonald, Chairman & CEO, myMatrixx

There’s no denying we are facing an opioid crisis in workers’ compensation. When opioids are prescribed temporary disability payments are 3.5 times higher. Even more concerning, prescription opioid overdose is now the second leading cause of accidental death in the U.S., killing more people than heroin and cocaine combined. There is good news though. The issue is being addressed more, bringing awareness to the epidemic — and it’s about time. myMatrixx has been focused on the potential dangers of pain medications since our inception in 2001. We feel it is our responsibility to not only monitor opioid use for our clients, but to also educate them on their appropriate use.

In our recent webinar, Opioids in the Treatment of Injured Workers, we looked at this growing problem. Claims handlers, and PBMs for that matter, can no longer assume the physician is using the recommended tools to monitor opioid use, abuse and diversion. The webinar was presented by Phil Walls, our Chief Clinical Officer and Brian Downs, VP of Workers’ Compensation Trust. It included best practices on effectively using opioids in workers’ comp and red flags to look for before they lead to major issues. Click here if you missed the webinar; it is now available to download on our website. Phil also recently spoke on this issue at the National Rx Drug Abuse Summit and will be presenting at several upcoming conferences, including PRIMA, FWCI and the National Workers’ Compensation & Disability Conference. If you are going to be at any of these, I invite you to attend his session which will cover some of the latest news and strategies on this topic. More details will be on facebook.com/mymatrixx as they become available.

myMatrixx will continue to stay at the forefront of this issue and provide education, awareness and tools to combat the dangers of opioids. But we need your help. Tackling this issue will require constant monitoring and action by everyone involved, from the claims handler, physician, PBM, pharmacist and even the injured worker. Together we can “do the right thing” for the injured worker and the industry.

For more articles from the myMatrixx Monitor Newsletter, click here.

myMatrixx Names Craig Rollins, Vice President of Ancillary and Business Development

http://www.prnewswire.com/news-releases/mymatrixx-names-craig-rollins-vice-president-of-ancillary-and-business-development-151374015.html

Tragic Headlines

Tags

Clinical, Opioid, Phil Walls, prescription drugs, Workers' Compensation

Phil Walls, R.Ph., Chief Clinical & Compliance Officer

It is not unusual to find stories in the news about drug abuse and diversion.  However, I find it particularly troubling to see three such dramatic headlines in one day:  “Survey Finds First-Time Abusers Of Painkillers Get Them From Friends, Family,” “More hand sanitizer drinking cases reported in dangerous trend,” and “TSA screeners at LAX arrested for narcotics trafficking, accepting bribes.”

All of these headlines occurred on April 25^th.  The first story dealt with a topic I blogged on recently, which is that our medicine cabinets are a major source of drugs that are ultimately diverted to the street for misuse and abuse.

The next story deals with our nation’s youth.  Many of you have heard me speak on the dangers of “dextromethorphan, which is an opioid that is available over the counter in cough products such as Robitussin DM and Delsym.  I have described it as the teenagers’ drug of choice for abuse because of its ready availability.  Well it seems that hand sanitizer poses an equal threat. Without going into the details of how the ethanol is removed from these products, please be aware that teenagers are able to easily convert this product into the equivalent of 120 proof alcohol.  There have been many cases of hospitalization because of alcohol poisoning.  Please keep these products out of the reach of children and monitor their use around teenagers.

Lastly, the often maligned TSA is under scrutiny again – this time for accepting bribes for “while large shipments of cocaine, methamphetamine and marijuana passed through X-ray machines at” the Los Angeles airport.  “Airport screeners act as a vital checkpoint for homeland security, and air travelers should believe in the fundamental integrity of security systems at our nation’s airports,” said United States Attorney André Birotte Jr. “The allegations in this case describe a significant breakdown of the screening system through the conduct of individuals who placed greed above the nation’s security needs.” All of the TSA agents known to be involved have been arrested and face up to life imprisonment. “TSA has assured the investigating agencies we will do everything we can to assist in their investigation,” said Randy Parsons, TSA Federal Security Director at LAX. “While these arrests are a disappointment, TSA is committed to holding our employees to the highest standards.”

Drug diversion is a serious concern in the United States today.  I do see it as the next form of risk for many insurers and payors in workers’ compensation.

Drug Diversion – How You Help

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Drug Enforcement Agency, injured workers, myMatrixx, National Association of Drug Diversion Investigators, National Prescription Drug Take-Back Day, Opioid, Phil Walls, prescription drugs, Workers' Compensation

By Phil Walls

According to The National Association of Drug Diversion Investigators (NADDI), the home medicine cabinet is a significant source of prescription drug diversion.  That fact is at least part of the reason for the Drug Enforcement Agency to establish its National Drug Take-Back days.

The next National Prescription Drug Take-Back Day is Saturday, April 28, 2012. Please help myMatrixx spread the word in order to reduce the number of accumulated unwanted, unused prescription drugs, through safe disposal programs.

Per the DEA, Americans who participated in the DEA’s third National Prescription Drug Take-Back Day on October 29, 2011, turned in more than 377,086 pounds (188.5 tons) of unwanted or expired medications for safe and proper disposal at the 5,327 take-back sites that were available in all 50 states and U.S. territories. When the results of the three prior Take-Back Days are combined, the DEA and its state, local, and tribal law-enforcement and community partners have removed 995,185 pounds (498.5 tons) of medication from circulation in the past 13 months.

Please help myMatrixx communicate this date to the injured workers that we provide care to.  We all fear what might happen with all of the controlled substances that are processed through the Workers’ Compensation system.  This is one way to make sure at least a portion does not end up on the streets.

 

Black Market Drug Pipeline

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Joe Paduda, Opioid, oxycodone, Phil Walls, Workers' Compensation

By Phil Walls

Thanks to Brian Downs at the Workers’ Compensation Trust in Connecticut for forwarding an article to Joe Paduda and myself this morning concerning a black market drug pipeline that runs from Florida to Connecticut.  Basically a black market operation in Florida would purchase oxycodone for about $5 a pill.  The illicit pills are then routed to Connecticut where they end up on the streets and sell for about $23 to $30 each.

Two thoughts on this: one, if we don’t drug test, we don’t know if patients are actually taking these meds or if they are diverting them, and two, based on Brian’s experience in law enforcement, a 30 day supply of oxycodone has an approximate street value of over $900!

I assured Brian that this story will be part of my PRIMA presentation in June “Drug Diversion:  A New Form of Risk”.  Remember that most of the oxycodone and other prescription meds that are diverted to the street were originally paid for by an insurance company!

How much should a urine drug screen cost?

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Ameritox, Clinical, Dominion Diagnostics, Joe Paduda, Millenium Labs, National Prescription Drug Abuse Summit, Opioid, urine drug screening, Workers' Compensation

By Phil Walls, Chief Clinical and Compliance Officer

As the National Prescription Drug Abuse Summit kicks off this morning, I am anxious to learn as much as possible on the subject of urine drug screening (UDS).  I had previously thought that I was well versed on this subject, but after making a comment last week during a live national webinar I heard that UDS is the next physician dispensing bandwagon, and I have since realized that I have a lot to learn on the billing side. It is not always enough to be a clinician apparently. It is imperative that we remove barriers such as high prices to this important monitoring tool. Joe Paduda also referenced this topic in his recent blog on Managed Care Matters.

What I have discovered so far is two basic differences in the UDS industry.  On the one side are companies like Dominion Diagnostics, Ameritox and Millenium Labs (I am sure that there are more that fall into this category but as I stated I have only begun investigating billing practices).  These companies are of course competitors and each has their own value proposition, but I admire their straightforward approaches to billing.  Basically the payor pays them directly.  Lee Pucket at Dominion offered some valuable information regarding a specific Workers’ Compensation panel that runs about $500.  You can’t get more straightforward than that.  He also pointed out that in certain states like California that the fee schedule limits that price to $400.

Ironic that I heard that comment linking UDS to physician dispensing  from an adjuster in California.  That adjuster was reimbursing physicians in the range of $2500 to $2700 dollars.  That does not seem in line with the fee schedule, but then the same was true of physician dispensing of prescription drugs in that state.

I have also received numerous copies of bills from what I presume are smaller UDS companies located in California.  Those bills have all been upwards of $900.

So far this looks like a California issue, but I would welcome any comments you can provide regarding your own experience with UDS billings.

It is of utmost importance that we solve this problem before these billing practices become a deterrent to the very important use of UDS in our industry.

New Hydrocodone Product Could Hit the Market Soon

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Clinical, FDA, Hydrocodone, Opioid, pharmacy, prescription drugs, Workers' Compensation

By Phil Walls, R.Ph., Chief Clinical and Compliance Officer

In 2005 (the most recent year for which I have accurate statistics) there were over 110 million prescriptions dispensed for hydrocodone combination products, which include Vicodin, Lortab, Lorcet, etc., in addition to all of the generic products available. It was, and still remains the number one prescription product in the United States. In fact, our country consumes 99% of the world’s supply of hydrocodone. Ironically, it is only the acetaminophen component in these combination products that limits the dose because of the severe liver damage that acetaminophen overdose may cause. If not for the acetaminophen, there would be no maximum dose for hydrocodone, which is a true statement regarding all opioids.

Thank goodness this drug is only available in combination products, right? Wrong. A new single source hydrocodone product, Zohydro, is currently making its way through the FDA’s review process and is poised to be what the New York Daily News has characterized as the “worst pill-popping plague since Oxycontin hit the streets.” (January 7, 2012). Ironically the manufacturer Zogenix characterizes it as “safer and more convenient” but please be aware it contains 10 times the amount of hydrocodone as in the lowest dose Vicodin-type product. Safer? I don’t think so.

According to Zogenix’s website (www.zogenix.com) Zohydro, if approved by the FDA, offers these benefits, “. . . greater patient convenience and another opioid option for chronic medication rotation.”

There may be some truth to this but only if appropriate Opioid management guidelines are followed. April Rovero, president of the National Coalition Against Prescription Drug Abuse, states “We just don’t need this on the market” and I agree. However, as I have stated before, this is big business! CBS News characterizes this as a “$10 billion-a-year legal market for powerful yet highly addictive opioid narcotics.”

Marketing of this drug could begin in 2013. This will be a real challenge for the FDA’s Risk Evaluation and Mitigation Strategy but only time will tell. I will keep you posted as this develops.