Prolific controlled substance subscribers still a concern

A new report from ProPublica raises concerns about physicians who prescribe a high number of controlled substances to Medicare patients. In addition to a 9 percent spike in narcotic painkiller prescriptions, the report found that 12 of Medicare's top 20 prescribers had a troublesome past, including criminal charges related to their medical practices or disciplinary actions from a state medical board.

The report comes on the heels of a series of pharmacy fraud cases across the country. It focuses specifically on prescription rates of controlled substances that have been a longstanding problem within Medicare Part D. ProPublica previously reported that Medicare fraud schemes flourish, often undetected, under the program.

In many cases, Medicare fails to flag providers with unusually high prescribing rates and fails to block doctors when there is a suspicion of fraud. That's why this year, the Office of Inspector General (OIG) called on the Centers for Medicare & Medicaid Services to ramp up Part D anti-fraud oversight, FierceHealthPayer: AntiFraud previously reported.

Soon after, CMS issued a final rule to screen drug prescribers more carefully. In November, the Government Accountability Office released an updated report that identified 23 practices for addressing prescription drug waste, fraud and abuse.

A review of data from 2012, before these initiatives took effect, shows an increase in prescribing rates for Schedule 2 drugs, particularly among physicians who have undergone criminal investigations or sanctions from their state medical board. For example, Shelinder Aggerwal, M.D., of Huntsville, Alabama prescribed more than 14,000 Schedule 2 drugs in 2012 before the state medical board suspended his controlled substances certificate. In Florida, 52 providers wrote at least 3,000 prescriptions for Schedule 2 drugs--more than doubled the number of offending providers in Tennessee.

Some pain specialists say that the CMS data doesn't paint the full picture. In some cases, state laws force physicians to prescribe on behalf of nurse practitioners and physician assistants, which significantly alters their prescription rates.

Meanwhile, the New York State Department of Health has implemented new rules that will eliminate prescription pads, according to The Daily Beast. Beginning March 27, 2015, all prescriptions must be filed electronically in an effort to better track prescribing practices and prevent theft of prescription pads that have been used to sell controlled substances in the past. In February, the Manhattan District Attorney's office broke up a Bronx-based drug ring that used falsely prescribed painkillers to defraud the state of hundreds of thousands of dollars.

Research shows that electronic prescription drug monitoring programs can effectively reduce prescription painkiller abuse, FierceHealthPayer: AntiFraud previously reported.

For more:
- read the ProPublica report
- see The Daily Beast article

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