Regulators ‘concerned’ after two Michigan doctors issue 23,000 medical Marijuana cards
The data raises suspicions, according to a recent audit.
Eighteen Michigan doctors were responsible for nearly 62% of 134,709 medical marijuana patient certifications cards issued in Michigan between April 1, 2021 and Sept. 29, 2022, according a performance review of Cannabis Regulatory Agency data.
Two of those doctors issued 23,033 certifications over 379 business days, a rate of more than 30 patients per day, nearly one every 16 minutes. Based on advertised certification fees that start near $100, those two doctors likely generated more than $2 million over that timeframe. The total revenue for all certifications would have exceeded $13.5 million.
Auditors cited a 2018 Physicians Foundation survey that found the vast majority of doctors felt “overextended” after seeing an average of between 11 and 20 patients per day. Based on the even-larger volumes of patients some Michigan doctors reported examining, the audit questioned if those certifications complied with legal requirements for issuing medical marijuana certifications.
The disproportionately large number issued by a small number of doctors “concerned” CRA officials, but they told auditors they don’t have the authority to report potentially unscrupulous activity, due to privacy rules and laws, the Aug. 24-published Office of the Auditor General report said.
“Although (law) and administrative rules require CRA to verify the application or renewal information, CRA informed us the (law) does not provide it with investigative authority to determine if a bona fide physician-patient relationship exists, and it would further need to refer the physician to (the Bureau of Professional Licenses) for investigation,” the audit said. “Further, CRA believes it does not have the authority to utilize the report information because of the patient-physician confidentiality provision in (the Michigan Medical Marijuana Act), which prohibits CRA employees from disclosing confidential information.
“However, this same provision also specifies CRA employees ‘may notify’ law enforcement about falsified or fraudulent information.”
The CRA checks with the Michigan’s Bureau of Professional Licensing to verify every certifying doctor’s credentials.
“We have had very few physicians try to certify the patient’s need for marijuana who aren’t licensed by the state or have provided inaccurate or incomplete license information about themselves – those applications have been denied,” CRA spokesman David Harns said. “We don’t keep statistics on denial reasons.”
State auditors were provided the physicians’ names, but they did not release them publicly.
“We cannot disclose the identifying information from the observation, as it is considered confidential information per the (Michigan Medical Marijuana Program Act),” said Office of the Auditor General spokesperson Kellie C. Miller. “Furthermore, law requires us to have the same duty of confidentiality as the data owner.”
Regulators have taken action against at least one doctor accused of issuing an exorbitant number of medical marijuana certifications in the past.
A doctor with clinics in Baldwin and Grand Rapids, who certified 21,708 medical marijuana between June 9, 2015 and June 8, 2016, at a pace of nearly 60 patients per day, was reported to the Board of Medicine in 2018 and received a two-year license suspension.
Certified medical marijuana patients are able to purchase more potent cannabis products and avoid the 10% excise tax that’s added to recreational marijuana purchases.
Due to the benefits of certification, applicants may “seek out physicians willing to provide certifications without establishing or maintaining a bona fide physician-patient relationship,” the audit said. “It is likely some of these physicians did not have a bona fide physician-patient relationship with the applicants.”
In order to be considered a “bona fide physician-patient relationship,” Michigan law requires the physician to review the patient’s relevant medical records, complete a full assessment of the patient’s medical history and current medical condition, keep record of their qualifying medical condition, reasonably believe there will be follow-up care and attempt to notify the patient’s primary doctor of their “debilitating condition” and medical marijuana certification.
In July, nearly 63 percent of applicants cited chronic pain as the condition that qualified them for a medical marijuana card.
With the advent of telemedicine, there are various online websites that offer access to medical marijuana card certifications. The certification fees start at about $100, but are often higher, require completion of a short questionnaire, stipulation that the patient has one of the qualifying medical conditions included under law and undergo a brief virtual video meeting with a licensed doctor.
Some online users report the process taking 15-20 minutes with same-day certification.
In addition to any physician fees, the state charges $40 for application processing. Certifications are valid for two years.
The Michigan Medial Marijuana Act, passed by voters in 2008, called for the creation of a program that certifies patients with certain medical conditions. They’re allowed to purchase medical marijuana and possess up to 12 plants or 2.5 ounces of marijuana flower. The CRA runs the program and also certifies caregivers, who are designated to grow and manufacture cannabis products for up to five patients, and themselves.
A caregiver with their own medical card and a full roster of patients may grow up to 72 plants and possess 15 ounces of harvested marijuana.
The number of caregivers and patients are amid a sharp decline.
For nearly two years following the December 2019 launch of Michigan’s recreational market, caregivers were allowed to sell their surplus marijuana products to the licensed market. That ended completely on Oct. 1, 2020. At the time, there were 241,221 registered patients and 30,629 caregivers.
Over the last year, the number of certified patients has dipped from 203,405 in August 2022, to 141,005 in July, an average loss of 5,640 patients per month. The number of caregivers declined from 22,867 in August 2022 to 13,244 in July, an average loss of 875 caregivers per month.
Additionally, there are fewer stores selling medical-designated cannabis. The CRA, during the first two years of recreational licensing, required retailers to also obtain medical marijuana licenses, but that condition no longer exists.
Fewer retailers are applying for medical marijuana licenses and a growing number are allowing active medical licenses to expire without renewal.
As of July, there were 296 licensed medical marijuana stores, compared to 704 recreational retailers.