The increasing death toll tied to drug overdoses in Pennsylvania has prompted state senators and law enforcement officials to push for an alternate approach to prescribing pain medication in the state.
Sen. Patrick J. Toomey (R-Pa.) and Sen. Debbie Stabenow (D-Mich.) held a Senate Committee on Finance Subcommittee on Health Care hearing Thursday at Allegheny General Hospital in Pittsburgh to discuss heroin and opiate abuse in the southwestern region of the state. The hearing included testimony from Shari M. Ling, M.D., deputy chief medical officer at the Centers for Medicare & Medicaid Services (CMS), who described the ongoing problems with fraud and abuse within Medicare Part D that are often tied to "pill mill" schemes.
Toomey, along with three other senators, proposed the Stopping Medication Abuse and Protecting Seniors Act, which would require at-risk Medicare beneficiaries to use just one prescriber to prevent doctor shopping, according to the Beaver County Times. Additionally, the newspaper reported that the Philadelphia division of the Drug Enforcement Administration plans to investigate pharmacies and physicians that overprescribe pain medications, relying on tips to root out fraudulent providers while the state implements a prescription-monitoring program.
FierceHealthPayer: AntiFraud previously reported on the link between the nation's heroine crisis and fraudulent payments for prescription drugs, pointing to the impact of two decades worth of overprescribing. Doctor shopping has been a pervasive problem within state programs as well as Part D. In August, four states spent an estimated $33 million on doctor shopping in which more than 16,000 beneficiaries visited five or more physicians for prescription drugs.
Doctor shopping cost four states $33 million in Medicaid fraud
Requiring Part D plan sponsors to report fraud activity would fix one of the program's many gaps
The escalating heroin crisis has roots in healthcare fraud
House subcommittee grills OIG, CMS on Part D fraud and abuse
Doctor shopping: What to look for, how to prevent it