Magazine article Drug Topics

Unauthorized Prescribers Bilk Part D out of $5.4 Million

Magazine article Drug Topics

Unauthorized Prescribers Bilk Part D out of $5.4 Million

Article excerpt

Estimates of the cost of Medicare fraud range broadly from $17 billion to $90 billion. However, there are no estimates of - or methods to detect - how much of the waste results from human error and not blatant crime.

A recent study from the Office of the Inspector General (OIG) found that in 2009 Medicare Part D paid for $5.4 million worth of Rx drugs ordered by individuals who clearly had no authority to prescribe, such as massage therapists and dieticians. The report raises concerns about both Medicare waste and patient safety.

However, OIG does not further explore how the inappropriate prescriptions were generated, which individuals or practices were involved, or why pharmacies filled the orders, said Lee Lasris, founding partner of South Florida's Health Law Center.

"It's too complicated a set of relationships to simply say there's a lot of inappropriate prescribing," Lasris said. "Are we talking about criminal conspiracy, or are we talking about mistakes?"

More than 29,000 of the improper Rxs were for controlled substances and came from nearly 5,000 different individuals with no prescribing authority. Drugs most often prescribed include simvastatin, lisinopril, hydrocodone-acetaminophen amlodipine besylate, and levothyroxine sodium.

Possible explanations

Even with today's electronic prescribing systems, logistical mistakes still occur in prescribing practice. Most electronic systems employ drop-down menus designed to help users quickly fill data fields. It seems plausible that medical office staff could accidentally choose the wrong name from a menu, or that a pharmacy technician might enter a legitimate prescriber's information incorrectly, resulting in a mistaken reference to a provider not authorized to prescribe.

"All kinds of people are connected to medical doctors who think they might be doing something the right way, and they're part of a process that can break down," Lasris said. 'If I operate under the authority or personal supervision of a doctor and he instructs me to write down the order, and an office clerk doesn't attach the physician's name to it and it just goes out, then ifs not as evil a situation as it seems to be in the OIG report."

For drugs that have street value, such as hydrocodone, the second most-prescribed drug in the report, the obvious explanation would be fraud, Lasris said.

"If the pharmacy fills a controlled-substance prescription and the Drug Enforcement Administration number is not on there, the pharmacy is supposed to inquire, at least. …

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