148 Million Dollar Bill For Medicare Drug Abuse

The General Accounting Office released a report (www.gao.gov ) and warned that a review on 2008 information found what appeared to be doctor shopping and 148 million dollars in inappropriate Medicare expenses.

In a report (GAO-11-699 that can be obtained at www.gao.gov), called Medicare Part D, Instances of Questionable Access to Prescription Drugs, the GAO found what looks like “doctor shopping” by roughly 1.8% of beneficiaries or 170,000 people who got prescriptions for frequently abused drugs from 5 or more doctors.

The GAO was asked to do this after a 2009 report on Medicaid appeared to show some unhealthy trends. Their task was to find out how many beneficiaries got any of the 14 categories of drugs that are often abused, to identify examples of doctor shopping and to determine what was done by the Centers for Medicare and Medicaid Services (CMS) to limit access to drugs by known abusers.

Three examples cited in the report were startling. In Georgia, a person got prescriptions for 3,655 oxycodone pills from 58 different prescribers. In California someone received 1,758 days worth of fentanyl from 21 prescribers and in Texas, someone got 4,574 hydrocodone pills from 25 different prescribers.

Senators who received and reviewed the report were critical of CMS. In their defense, the challenge is to allow reasonable access to medicines (versus restricting beneficiaries to a single doctor or pharmacy), while preventing people who are “doctor shopping” to get ridiculous quantities of pills.

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