Report faults Medicare controls on widely abused drugs

Introduction

Tens of thousands of Medicare beneficiaries are obtaining prescriptions for addictive drugs from multiple doctors, says a new auditor’s report, underscoring the need for Medicare to better police its drug benefit program – an issue highlighted early this year by iWatch News.

During 2008, 170,000 Medicare Part D beneficiaries acquired frequently abused drugs — primarily hydrocodone and oxycodone — from five or more doctors, at a cost of $148 million, according to a report to be released later today by the Government Accountability Office (GAO). According to the investigation on so-called doctor shopping, 600 Medicare beneficiaries received prescriptions from as many as 87 medical practitioners in the same year.

The GAO said the Centers for Medicare and Medicaid Services (CMS) has systems in place to identify inappropriate drug use by beneficiaries, but said that “measures to stop the activity are limited.” The watchdog agency also said stricter controls over prescription drugs are needed to reduce drug abuse and addiction. CMS is part of the Department of Health and Human Services.

In addition to addicts who seek out drugs for personal use, Medicare has long been a lucrative target for criminals who exploit the program for profit. Attorney General Eric Holder estimated the program loses $60 billion a year to fraud.

Early this year, iWatch News reported that criminals successfully billed Medicare for prescription drugs using the names of deceased physicians, a scam that is difficult to catch due to inadequate CMS oversight of contractors. At that time, CMS was not checking to make sure that prescriptions paid for by the program were written by real doctors. Oversight of contractors was so inadequate that the agency could not identify the top prescribers of oxycodone and Ritalin, two highly addictive drugs that are often trafficked on the streets.

To address the doctor shopping problem, the GAO report recommends Medicare administrators consider forcing suspected patients to receive prescriptions from a single prescriber, a single pharmacy, or both, an initiative that has been successful for some private insurance plans. It suggested Medicare administrators consider starting such a program by focusing on hydrocodone and oxycodone. In response to the report, Medicare administrators agreed the program needs to improve efforts to “curb overutilization,” but disagreed that a restricted recipient program was necessarily the solution.

Sen. Tom Carper, D-Del., one of those who requested the GAO inquiry, said the abuse of drugs by beneficiaries “strains an already costly program, wastes taxpayer dollars and steals resources from seniors and the disabled who need the program’s critical assistance.” Sen. Scott Brown, R-Mass., a co-requester of the report, said CMS “must immediately increase its oversight of this important program and begin notifying proper law enforcement agencies of potential abuses.”

Witnesses from the GAO and the Centers for Medicare and Medicaid Services are expected to testify on the issue at Senate subcommittee hearing later today.