By Catherine J. Frompovich
Guess what? The older generation is costing Uncle Sam’s Medicare too doggone much money in the way of prescription drugs! It seems the Medicare ‘crowd’ is using too much of the prescription part “D” in Medicare, either fraudulently or otherwise. But who writes the ‘scripts’ (Rxs) for these drugs in most cases? MDs! Where’s an accountability factor for them?
In a press release dated December 13, 2011 under the subtitles of “Cracking Down on Fraud” and “New Steps to Prevent Fraud with OxyContin, Percocet, and Other Prescription Drugs,” the feds say this:
As a next step in an aggressive campaign to crack down on Medicare fraud, HHS will direct all Medicare prescription drug plans to use every tool at their disposal to prevent fraud. Patients sometimes “doctor shop,” visiting numerous doctors to get multiple prescriptions for OxyContin, Percocet, and other painkillers and narcotics. In some cases, these medicines are abused by the patients, in others, patients sell the extra drugs.
OxyContin and Percocet abuse, prescription drug fraud, and so-called “doctor shopping” are major problems. The Government Accountability Office recently reported that “170,000 Medicare beneficiaries received prescriptions from five or more” doctors for drugs that are frequently abused, like OxyContin and Percocet.
While not all of these cases are fraudulent, some are. In 2008, for example, one Medicare beneficiary “received prescriptions for a total of 3,655 oxycodone pills [such as OxyContin]…from 58 different prescribers.”
Today, HHS announced they have urged insurance companies to take every step possible to prevent such fraud. Specifically, HHS’ guidance tells prescription drug plans to withhold payment on suspicious claims, including when enrollees use multiple doctors to obtain painkillers and narcotics. Companies that offer prescription drug plans already process each of a patient’s prescriptions. While HHS generally requires prompt payment, today’s guidance clarifies that if a plan sees signs of suspicious activity, it should withhold payment to pharmacies until it verifies the claim is valid.