What Happened
Three employees of the VA John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas, were charged with conspiring to steal and distribute prescription medications, including opioids, from the VA.
The investigation began in June 2016 after the VA Office of Inspector General received a report that large amounts of unaccounted-for prescription medications were being charged to VA accounts. Investigators determined that a pharmacy technician used his VA access to a medical supplier's web portal to order and divert roughly 4,000 oxycodone pills, 3,300 hydrocodone pills, 308 ounces of promethazine with codeine syrup, and more than 14,000 Viagra and Cialis pills — at a cost to the VA of about $77,700 and a street value exceeding $160,000 — falsifying payment invoices to avoid detection.
Investigators further found that he distributed a portion of the medications to another pharmacy technician, who in turn passed some of the drugs to a pharmacy technician student trainee. A federal indictment unsealed February 8, 2017, charged all three with conspiring to steal the medications, and two of them with additional counts of conspiracy to distribute and possession with intent to deliver oxycodone.
What Went Wrong
A pharmacy technician was able to use ordinary supplier-ordering access to route large volumes of opioids and other controlled substances out of a VA hospital, undetected until an unrelated billing anomaly surfaced. Key failures included:
- A single pharmacy technician's web-portal ordering access to a medical supplier was not subject to independent approval or quantity-threshold review.
- Falsified payment invoices were accepted without a reconciliation step that would have compared ordered quantities against actual patient-level dispensing needs.
- The scheme was discovered through an unrelated report of unaccounted-for charges to VA accounts, not through the pharmacy's own controlled-substance oversight.
- No safeguard prevented a technician from routing diverted drugs onward to other employees, allowing the scheme to spread beyond one person's access.
How It Could Have Been Prevented
- Require pharmacist or supervisory approval, independent of the ordering technician, for all controlled-substance orders placed through supplier web portals.
- Reconcile ordered quantities of controlled substances against actual patient census and dispensing needs on a recurring basis to catch outsized orders.
- Audit payment invoices for controlled-substance purchases against verified delivery and dispensing records rather than accepting technician-submitted documentation at face value.
- Monitor for unusual peer-to-peer patterns among pharmacy staff that could indicate onward distribution of diverted drugs.
- Treat unexplained billing or accounting anomalies tied to controlled substances as a trigger for a full diversion audit, not just a financial correction.
Related Guidance
- Hospital Diversion Prevention Checklist — Hospital self-assessment, 8 sections 63 items, including inventory, recordkeeping, and DEA reporting controls.
- CSOS Electronic Ordering Guide — Controls for electronic ordering of controlled substances.
- 15 Red Flags of Drug Diversion — Behavioral and transactional indicators including inventory irregularities.
- Employee Screening & Fitness for Duty — DEA screening requirements (21 C.F.R. §1301.90) and pre-employment vetting for staff with controlled substance access.