By Melissa Daniels | PA Independent
HARRISBURG — Prescription pills are readily available, and you don’t need a doctor, or even a drug dealer, to get them.
Medicare has covered thousands of fraudulent prescriptions issued by people who aren’t even allowed to prescribe drugs in the first place, a federal report shows.
The Department of Health and Human Services Office of Inspector General found Medicare Part D inappropriately covered $26 million worth of prescription drugs in 10 states in 2009.
The June report found Part D covered more than 344,000 prescriptions from people without any prescribing authority — counselors, social workers, chiropractors and physical therapists, for example.
Most of the drugs were common ones – such as cholesterol and high blood pressure medicine, or the painkiller hydrocodone-acetaminophen. But more than 29,200 of these were for controlled substances, or the kind of drugs regulated by the Drug Enforcement Agency, including oxycodone.
Here in Pennsylvania, the study found more than 17,600 prescriptions made by unauthorized prescribers, resulted in more than $1.3 million in Medicare payments.
Pennsylvania transactions accounted for 5 percent of all fraudulent Medicare Part D payments in the study. California and Florida made up most cases, a combined 45 percent.
On average, each poser prescriber filed 27 prescriptions a year. Others were more routine — 32 of the more than 12,000 cases had more than 1,000 fake prescriptions filled in a year.
Medicare Part D is meant to offset prescription costs for senior citizens already enrolled in Medicare. Nationwide, more than 36 million Americans are enrolled, according to the Centers for Medicare and Medicaid Services.
CMS contracts with private insurers to provide the coverage, called “plan sponsors.” Under current law, sponsors have some compliance guidelines, yet they aren’t required to verify whether authorized physicians wrote the script, according to the OIG report.
Unauthorized prescriptions are, in turn, paid for inappropriately on three counts: from the federal government, the insurance companies, which pick up the balance, and the beneficiaries.
Harrisburg-based attorney Larry Selkowitz formerly worked at the U.S. Attorney’s Office for the Middle District of Pennsylvania, in the health-care fraud division. He still works on cases of Medicare and Medicaid compliance.
He said the companies verifying prescriptions before securing Medicare payments have systems to verify individual identification numbers, but these can be forged by mimicking the pattern. Or, the system can be turned off.
“It’s so data intensive that if they don’t have really good data screening and don’t use their data screening, then these things are going to get paid,” he said. “And that’s what fraudsters are counting on.”
Selkowitz said the key to spotting fraud is often as simple as an unrealistic pattern — a subscriber number associated with too many patients or requests in one day, for instance.
HHS decided to look into Medicare Part D fraud after concerns about the rise of prescription drug abuse.
“The Centers for Disease Control and Prevention has characterized prescription drug abuse as an epidemic,” reads the report’s introduction. “With the rise in prescription drug abuse, concerns about Medicare fraud, particularly prescriber fraud, have increased.”
In addition to the state-based investigations, the inspector general looked at another group of 14 medical and health-related professionals who were unable to prescribe but were nevertheless issuing scripts covered by Medicare Part D. This group included massage therapists, dieticians, health aides, athletic trainers and audiologists – and some non-health related fields, such as contractors and transportation companies.
The group filed more than 72,000 prescriptions with a total cost of more than $5 million.
Some were more egregious than others: In Florida, a massage therapist ordered 3,756 prescriptions that cost more than $183,000 while a dietician ordered 2,645 prescriptions for 165 people.
A total of 121 prescriptions from veterinarians were also covered, at a cost of $6,080.
A New Jersey congressman and Senate hopeful followed up with legislation to address the problem. A bill from Rep. Frank Pallone Jr., D-N.J., would require the insurance companies processing Part D payments to verify that controlled substance prescriptions were made by authorized physicians.
“Millions of Americans benefit from Medicare’s drug coverage program each year, which is why it’s imperative that checks are in place to prevent fraud and abuse as well as to protect patients,” said a statement from Pallone.
“We cannot allow Medicare’s prescription drug program to be compromised at taxpayer expense,”
Contact Melissa Daniels at email@example.com