Thousands of recipients suspected of "doctor shopping" for frequently abused prescription drugs
Oct 04 2011
WASHINGTON – Today, Sen. Tom Carper (D-Del.), Chairman of the Subcommittee on Federal Financial Management, and Sen. Scott Brown (R-Mass.), Ranking Member, released the results of recent investigation that reveals individuals defrauding the Medicare system to abuse and sell prescription drugs in Medicare Part D. The Government Accountability Office (GAO) found indications of "doctor shopping" in the Medicare Part D program for 14 categories of frequently abused prescription drugs, including hydrocodone, fentanyl and oxycodone. The investigation revealed that 170,000 Medicare Part D beneficiaries acquired the same class of frequently abused drugs from five or more doctors during 2008 at a cost of about $148 million. In a particularly egregious example, one individual received prescriptions from 87 different medical practitioners in 2008.
While the Centers for Medicare and Medicaid Services (CMS) relies on Part D plan sponsors to identify "doctor shopping" for prescription drugs, the federal government does not restrict beneficiaries' access to highly-addictive and highly-abused drugs. GAO recommends that CMS improve its efforts to curb the exploitation of Medicare Part D, and suggests that CMS implement a restricted recipient program for beneficiaries who "doctor shop" and seek congressional authority to limit those beneficiaries' access to highly-abused drugs, as appropriate.
"Millions of Americans depend on Medicare Part D to purchase much-needed medication to help them go about their daily lives," said Sen. Carper. "Unfortunately, this vital program is not immune to exploitation. The abuse of prescription drugs purchased through the Medicare Part D program strains an already costly program, wastes taxpayer dollars and steals resources from seniors and the disabled who need the program's critical assistance. As prescription drug abuse rises across our nation, particularly among young people, it is disturbing to think that our public health care system could be subsidizing a major public health crisis. Moreover, at a time when we are focused on curbing our nation's overwhelming budget deficit, we need to do all that we can to prevent scarce resources from being lost to waste and fraud. I will continue to work with my colleagues in the Senate and the Administration to find solutions to curb the problem GAO has identified and to prevent similar instances of waste and fraud moving forward."
"While seniors and Medicare Part D beneficiaries are struggling to pay for their legitimate prescription drug needs, there are people abusing the system to obtain, for example, the obscene amount of nearly 6,000 oxycodone pills a year," said Sen. Brown. "Beyond the fraud and abuse, taxpayer dollars are potentially being used to fuel the illicit prescription drug trade. In some cases, beneficiaries have seen more than 80 different medical practitioners to obtain narcotic drugs. Incredibly, when faced with evidence of this so-called 'doctor shopping,' CMS's standard response is simply to send an educational letter to the doctors. CMS must immediately increase its oversight of this important program and begin notifying proper law enforcement agencies of potential abuses. CMS should work harder to ensure taxpayer dollars are used appropriately for Medicare beneficiaries."
Today, the Subcommittee on Federal Financial Management will hold a hearing to discuss the GAO report and examine the fiscal impact of fraud and abuse of prescription drugs in the Medicare Part D program. The Committee Members will hear testimony from witnesses on the taxpayer costs of such abuse and how it affects our public healthcare system overall. Witnesses, including officials from GAO and CMS, are also expected to discuss what government officials are doing to identify and prevent exploitation of the program. The hearing takes place today, Tuesday October 4 at 10:30 am in Dirksen 342. A webcast of the hearing, "Costs of Prescription Drug Abuse in the Medicare Part D Program," is available here.