Nurse practitioners and physician assistants missing from CMS drug payment data

Although the majority of states allow nurse practitioners (NPs) and physician assistants (PAs) to prescribe medication, the two groups were noticeably absent from Centers for Medicare & Medicaid's (CMS) release of payments made from drug and device manufacturers to physicians and teaching hospitals.

Despite the fact that NPs and PAs account for 10 percent of Medicare Part D prescriptions, the federal Physician Payment Sunshine Act does not require companies to report payments to these providers, according to ProPublica. PAs and NPs accounted for 15 percent of all prescriptions during the first five months of this year, the article notes.

However, these types of practitioners are not shielded from fraud and false claims litigation. Last week, Heather Alfonso, an Advance Practice Registered Nurse (APRN) in Connecticut, pleaded guilty to accepting $83,000 in speaking fees from the pharmaceutical manufacturer of a cancer pain drug. Alfonso was the highest prescriber of the pain medication in the state, with more than $1 million in claims.  

"Nurse practitioners see patients, order tests, recommend procedures and prescribe medications," Walid Gellad, M.D., an associate professor of medicine at the University of Pittsburgh and co-director of the Center for Pharmaceutical Policy and Prescribing, told ProPublica. "It seems straightforward to think that their relationships with the pharmaceutical and device industries are of as much relevance as physicians, dentists, chiropractors, etc."

A 2010 survey of NPs published in the American Journal of Managed Care indicated that 90 percent of NPs believed it was acceptable to attend pharmaceutical industry-sponsored lunches. The study's author, Elissa Ladd, associate professor of nursing at the MGH Institute of Health Professions in Boston, told ProPublica that many NPs believe that they are "somewhat immune" to mandatory payment disclosures.

This week's FierceHealthPayer: Antifraud column details some of the emerging trends tied to the recent data released by CMS, including potential kickback liability for physicians that receive a high number of payments from drug and device manufacturers.

For more:
- read the ProPublica article

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Without accountability, pharma will happily keep dishing out kickback settlements