By Julian Pecquet
Senators from both parties on Tuesday urged the Medicare program to clamp down on beneficiaries who abuse prescription drugs after an independent audit documented widespread doctor-shopping.
The Government Accountability Office scoured more than a billion prescriptions and found that 170,000 beneficiaries visited five or more doctors to get 14 classes of frequently abused pharmaceuticals. That figure represents 1.8 percent of the beneficiaries who received those classes of drugs — and a value of $148 million, much of it paid by the Medicare program.
“Medicare dollars are being used to finance prescription drug abuse in our nation,” Gregory Kutz, the GAO’s director of forensic audits and special investigations, told the Senate Homeland Security and Governmental Affairs subcommittee on Federal Financial Management, Government Information, Federal Services and International Security. “The GAO is hopeful that Congress and [the Centers for Medicare and Medicaid Services] will use this report to improve the integrity and the safety of the Medicare Part D program.”
The top Democrat and Republican on the subpanel have already sponsored anti-fraud legislation that would strengthen prescription-drug monitoring and require closer coordination between the Medicare program, its oversight contractors, the Drug Enforcement Administration and state and local law enforcement officials.
They pressed CMS for more action during Tuesday’s hearing.
“Aside from our financial imperative,” subcommittee Chairman Tom Carper (D-Del.) said, “we have a moral imperative to ensure that our public healthcare system isn’t used — or misused — to further intensify and subsidize a public health crisis.”
Sen. Scott Brown (R-Mass.), the subcommittee’s ranking member, said the facts revealed by the report were “unconscionable.”
“We must do everything we can do to create a stronger oversight of these controlled substances,” Brown said. “In fact, in some cases our entitlement programs — which were established to benefit our country’s most vulnerable — instead are being used to fuel addiction and abuse.”
Jonathan Blum, the deputy administrator at CMS, defended the program.
“We must shift our focus to overutilization of drugs,” he acknowledged, but added that CMS has already taken steps to get there. Last week, the agency issued new guidance for Part D plans, suggesting that they start denying beneficiaries at the point of sale if they suspect abuse.
The GAO wants Medicare to go one step further and limit identified doctor-shoppers to one prescriber and one pharmacist. Blum pushed back against the idea, saying it could discriminate against people who “may have very legitimate healthcare needs” for seeing multiple specialists.
Still, Blum concluded, “CMS fully agrees that more needs to be done.”