Study: Medicare pays for unauthorized prescription drugs

New research reveals unlicensed healthcare providers are writing hundreds of thousands of prescriptions a year


Tracy WeberJennifer LaFleurand Charles Ornstein
June 24, 2013 10:48PM (UTC)
This originally appeared on ProPublica.

ProPublica

Hundreds of thousands of times each year, Medicare pays for prescriptions purportedly written by massage therapists, athletic trainers, interpreters and others who aren’t allowed to prescribe drugs, according to a new federal report.

The study released today by the inspector general of the U.S. Department of Health and Human Services, identified more than 417,000 such prescriptions paid for by Medicare’s prescription drug program in 2009. The tally included initial prescriptions and refills dispensed by pharmacies.

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The inspector general found nearly 30,000 prescriptions for painkillers and other easily abused drugs that appeared to be prescribed by individuals who had no authority to do so. Such prescribing could “endanger patients” and “may also contribute to the prescription drug abuse problem in our nation,” the report said.

The cost of all the questionably prescribed drugs came to $31.6 million, according to the study. Although just a small fraction of total drug spending in the program, known as Part D, it raises questions about how closely Medicare tracks the validity of prescriptions or investigates those that appear suspicious.

“In a prescription drug program like Part D, $31 or $32 million may not sound like a lot, but every little bit adds up,” said Sen. Tom Carper, D-Del., chairman of the Senate Homeland Security and Governmental Affairs. “We don’t have the money in Medicare to be wasting for this area.”

Carper’s panel has scheduled a hearing this afternoon on prescription abuses in the program, which cost the government $62 billion last year.

The report is the second in days in which the inspector general faulted Medicare for its lax oversight of the program. On Thursday, the IG said it had identified more than 700 doctors with highly questionable and potentially dangerous prescribing patterns and called on Medicare to do more to investigate them.

It was not clear from the new report whether the drugs were actually prescribed by the massage therapists and others or if a pharmacy had mistakenly attributed drugs to them that were legitimately prescribed by others. Another possible explanation is that the prescriptions were fraudulent.

The inspector general identified prescribers and their specialties using a federal database that includes unique identification numbers, addresses and practice information reported by providers, including their primary specialties.

Analysts tried to exclude those who may have had authority to prescribe drugs despite appearances. For example, someone who identified himself or herself primarily as a dietician also may be a licensed physician.

In its response to the study, the Centers for Medicare and Medicaid Services (CMS) said some of the examples cited by the report may be due to weaknesses in the federal database relied upon by the inspector general. CMS said it is working to shore up the database, but noted it relies on health professionals to keep their information up-to-date.

Even so, the agency said it would ask its fraud contractor to examine the issue and it would investigate the examples found by the inspector general.

“We have already launched several efforts to address these vulnerabilities, such as an intervention program in an area of high drug abuse and better data analyses to detect patterns of fraud and abuse,” an agency spokesman said in an email to ProPublica. “We agree with the OIG recommendations and are evaluating next steps to continue improving our oversight of Part D.”

The inspector general’s office said its analysts did not contact providers to ask if they had actually prescribed the drugs.

The report highlights, but doesn’t name, a Florida dietician as having ordered about 2,600 prescriptions for 165 patients.

ProPublica used Medicare data it had previously obtained to identify a Florida dietician with a similar tally in 2009, the same year studied by the inspector general. Rocio Garcia, a dietician at Jackson Memorial Hospital in Miami, said she’s never prescribed a drug: “I can’t. I’m not a doctor.”

“I don’t know what to make of this,” Garcia said. “How could they link my name to [the prescriptions] if I’m not a doctor?”

To make sure that payments are accurate, the inspector general said Medicare should require the private insurers that administer Part D to verify that a provider has authority to prescribe drugs before paying for them.


Tracy Weber

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Jennifer LaFleur

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and Charles Ornstein

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