Investigation Finds Medicare Patients Abusing and Dealing Prescriptions Drugs

Investigation Finds Medicare Patients Abusing and Dealing Prescriptions Drugs

A new national report is confirming the extent of the prescription drug abuse epidemic taking place in the U.S. after reviewing the government’s own health care program. As many as 170,000 Medicare recipients have been classified as prescription drug abusers or dealers, otherwise known as ‘doctor shoppers,’ based on the findings of the report.

Unlike other addictions that involve street drugs like cocaine or heroin which have no accepted medical use, the prescription drug abuse epidemic-specifically the Medicare fraud uncovered in the report-is being financed by the federal government via taxpayer dollars, as described by the report’s author, investigator Gregory Kutz.

The report, conducted by the U.S. Government Accountability Office (GAO) as an audit of Medicare’s Part D program, found that the 170,000 identified Medicare beneficiaries were receiving prescriptions from five or more doctors each, for any of the twelve most frequently abused controlled substances including oxycodone; amphetamine/dextroamphetamine (Adderall); benzodiazepines such as diazepam (Valium) and alprazolam (Xanax); acetaminophen with codeine; and the two most commonly abused uncontrolled prescription drugs, the non-narcotic painkiller tramadol (Ultram and Ultracet) and the muscle relaxer carisoprodol (Soma). The amount of doctor shopping that took place from May 2010 to October 2011 resulted in a cost of $148 million to the Medicare program.

Due to the rise in prescription drug abuse spreading across the nation-now the second leading cause of death from unintentional injuries, preceded only by motor vehicle fatalities-the GAO conducted a thorough investigation on prescription drug abuse and fraud taking place within the Medicare Part D program. Like many insurance companies and public programs, Medicare is inadvertently funding the illegal prescription drug activity and contributing to the nation’s leading addiction as doctor shoppers continue to be able to cheat the Medicare program.

In its investigation, the GAO sought to determine the extent of doctor shopping occurring within the Medicare program, highlight some prototypical cases of doctor shopping, and to use the information to help create a new method of monitoring and regulating the illegal activity within the government program.

Although they make up a small percentage of Medicare beneficiaries receiving prescriptions for any of the 14 classes of commonly abused drugs, the majority of the 170,000 Medicare beneficiaries identified as doctor shoppers were not on Medicare because of their age, but rather 71% had coverage for a disability and 72% were enrolled in the Medicare Low-Income Cost-Sharing subsidy. In one example, a beneficiary successfully obtained a 944-day supply of hydrocodone pills from 25 different prescribers. Another beneficiary successfully obtained 1,397 fentanyl pills and patches from 21 different doctors. A third beneficiary obtained 3,655 oxycodone pills from 58 different doctors, filling the prescriptions at 45 separate pharmacies. The report also uncovered 600 Medicare cases in which beneficiaries received prescriptions from as many as 87 different doctors in a one-year time frame, the majority of which were for oxycodone and hydrocodone. Not only are these beneficiaries able to shop around providers within the system to obtain as many prescriptions as possible, but their excessive activity can go virtually undetected, as beneficiaries with low incomes have the ability to switch their Medicare plans monthly, practically covering their tracks. Regular Medicare beneficiaries, on the other hand, are only able to change plans annually.

In the GAO’s analysis, the doctors providing the prescriptions to the doctor-shopping individuals were unaware that their patients were also receiving prescriptions from other physicians, and would not have prescribed the drugs had they known their patients had access to the same drug from other prescribers. Although the current Medicare system monitors unnecessary or inappropriate prescription drug activity performed by patients, no penalty exists for doctor shopping in the Medicare program, allowing beneficiaries to continue to seek out multiple prescriptions from several doctors without losing their enrollment.

As a solution, the GAO report recommends restricting known doctor shoppers in the Medicare program to just one doctor and one pharmacy, as well as circulating the name and information of the doctor shoppers to all insurance providers connected to Medicare’s Part D program. In the meantime, the report encourages the 3,400 various Medicare Part D plan providers to implement additional steps in detecting doctor shopping activity, and to report the incidents to the federal government.

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