|Medicare Paid for Fraudulent Prescriptions|
|Chris Good||Jun 21, 2013, 8:04 PM|
Image credit: Getty Images
In 2009, massage therapists, athletic trainers, chiropractors and other professionals wrote hundreds of thousands of drug prescriptions without the authority to do so.
In some cases these were controlled substances like oxycodone, but Medicare Part D, which covers prescription drugs, paid for them anyway.
A report by the Department of Health and Human Services' inspector general outlines how, in 2009, Medicare's prescription-drug benefit paid for prescriptions written by health and health-related professionals who did not have the authority to write them under Medicare's rules. Prescriptions were written by massage therapists, athletic trainers, dietitians, audiologists, opticians, contractors, home health aides, interpreters, transportation companies, lodging companies, speech-language assistants, music and art therapists, nursing technicians, veterinarians.
Through the private insurers that contract as Medicare Part D providers, the total came to $5.4 million for 72,552 of these prescriptions nationwide.
Another $26.2 million was paid out for prescriptions written by social workers, chiropractors, physical therapists, occupational therapists, and counselors-another group of professionals who also didn't have the authority to prescribe these drugs-in the 10 states that account for more than half of all Medicare Part D payments. (Those states are California, Florida, New York, Texas, Pennsylvania, Ohio, Illinois, North Carolina, Michigan and New Jersey.)
ABC News obtained the report exclusively.
In 2009, a Florida massage therapist wrote 3,756 prescriptions for drugs, for instance. An interpreter wrote 1,210, and an Ohio social worker ordered 1,639.
Congress is looking into it.
On Monday, the Senate Homeland Security and Governmental Affairs Committee, led by Chairman Tom Carper, D-Del., and Ranking Member Tom Coburn, R-Okla, will hold a hearing on the report.
"For a physical therapist, a massage therapist, there may be things that they should be able to write a prescription for, they could be reimbursed by Medicare," Carper told ABC News in an interview on Thursday. "Should they be writing prescriptions for controlled substances? No! Can we stop that? Yes, we can."
The cost is a threat to Medicare's fiscal stability, Carper said.
"I think we are talking the loss of tens of millions of dollars from the Medicare trust fund, money that we don't have," Carper told ABC News.
The inspector general's report details stunning numbers of prescriptions that shouldn't have been written, by people who shouldn't have been writing them, across the nation and across the 10 states studied in depth. The Centers for Medicare and Medicaid Services, the report states, "does not specifically require sponsors [private insurers that contract with Medicare] to verify that drugs are ordered by individuals who have the authority to prescribe."
From the report:
Notably, massage therapists ordered 12,082 prescriptions in 2009. Athletic trainers ordered another 8,795. Contractors ordered 2,872 prescriptions; these individuals complete home repairs or modifications to accommodate a health condition, such as wheelchair ramps. Others who ordered prescriptions paid by Part D included personal care providers (e.g., home health aides, chore providers, and companions), interpreters, transportation companies (e.g., taxis, private vehicles, and drivers), lodging companies, and veterinarians. …
An in-depth analysis of 10 States revealed that Part D inappropriately paid for 344,714 prescriptions ordered by other selected types that did not have the authority to prescribe. In total, Medicare paid $26.2 million for drugs ordered by counselors, chiropractors, social workers, physical therapists, and speech-language pathologists. Our review of State laws found that these prescriber types did not have the authority to prescribe drugs in any of the 10 States. …
[C]ounselors ordered 87,400 prescriptions, the most of the prescriber types reviewed in the 10 States. Counselors include such professions as marriage and family therapists. Chiropractors were next, with 70,681 prescriptions, folllowed by social workers, with 69,075 prescriptions.
The inappropriate payments could signal that prescriber-ID numbers had been stolen, both Carper and the IG report hinted. And the problem isn't just about taxpayer money, but the widespread problem of prescription-drug abuse.
Most of the prescriptions were for commonly used drugs, the report states, but in total, 29,212 prescriptions for controlled substances were ordered by 4,863 individuals who shouldn't have been prescribing them. Medicare paid over $1.5 million for those drugs. Of those prescriptions, 7,679 were Schedule II drugs-like oxycodone and morphine-defined by the Drug Enforcement Administration as drugs with "high potential for abuse … with use potentially leading to severe psychological or physical dependence."
In 2011, the Centers for Disease Control declared prescription-painkiller overdoses an epidemic.