Too Many Rx Prescriptions = Fraud?

Posted on 06/25/2013 by | AARP Utah | Comments

Diagnosis: possible Medicare fraud.

 [Reprinted from the May AARP Bulletin.]

medicare-pillThat’s the gist of a report from the Inspector General of the U.S. Department of Health and Human Services that found hundreds of doctors with “very extreme” prescribing practices — practices that could be harming Medicare patients and costing the government untold millions.

Government investigators zeroed in on doctors writing hundreds of prescriptions per patient and large numbers of prescriptions for painkillers and other addictive drugs, among other practices.

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After sifting through the prescription records of 87,000 general-care physicians who had patients in the Medicare Part D program in 2009, the investigators classified 736 as “extreme outliers.” One California doctor, for example, wrote prescriptions that cost Medicare $9.7 million (151 times more the average), and an Illinois doctor wrote prescriptions filled by 872 pharmacies in 47 states and Guam.

“Some of their prescribing may have been appropriate,” the report notes. “However, prescribing high amounts on any of these measures may indicate that a physician is prescribing drugs which are not medically necessary or that he or she has an inappropriate incentive, such as a kickback, to order certain drugs.”

Sen. Tom Coburn (R-Okla.), a medical doctor himself, told the nonprofit news organization ProPublica that Medicare officials “should be using their data to make sure those practicing medicine are practicing medicine and not practicing a sham.”

ProPublica notes: “The study mirrors a ProPublica investigation last month that found Medicare had failed to protect patients from doctors and other health professionals who prescribed large quantities of potentially harmful, disorienting or addictive drugs.”

The inspector general’s report calls on the Centers for Medicare and Medicaid Services to step up its scrutiny of doctors with questionable prescribing patterns and to help the private insurers that administer Medicare Part D do the same. It also recommends that Medicare send doctors who participate in the program report cards that comparing their prescribing practices to those of their peers.

The Senate Homeland Security and Government Affairs Committee has scheduled a hearing on prescription drug abuse in Medicare’s Part D program for June 24.

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