Grassley: Are high prescription rates a sign of fraud?

A Miami doctor wrote nearly 97,000 prescriptions in 18 months for mental health drugs. An Ohio physician wrote more than 100,000 prescriptions in two years. A Texas doctor wrote more than 14,000 prescriptions for the anti-anxiety drug Xanax. These alarmingly high prescriptions numbers for mental health drugs covered by Medicare and Medicaid have prompted Senator Charles Grassley (R-Iowa) to call for an investigation, the Associated Press reports.

"The federal government has an obligation to figure out what's going on here," he wrote in an email sent to the AP last week. "The taxpayers are footing the bill, and Medicare and Medicaid are already strained to the limit. These programs can't spare a dollar for prescription drugs that aren't properly prescribed."

Grassley, a ranking member of the Senate Finance Committee, which oversees Medicare and Medicaid, noted that it's possible there wasn't any fraud. Still, he maintained the importance of clarifying what was going on and fixing whatever was broken. His comments came after he sent a letter to Department of Health and Human Services Secretary Kathleen Sebelius and Centers for Medicare and Medicaid chief Donald Berwick, complaining that CMS wasn't doing enough to oversee contractors to prevent fraud and abuse.

Doctors who call attention to themselves with high drug prescribing rates may face a medical review, but critics say they allow CMS to ignore a Medicare fraud problem worth an estimated $60 billion to $90 billion a year.

Kirk Ogrosky, a former federal prosecutor and a lawyer with Arnold & Porter, told the AP that Medicare's contractors, who monitor Medicare prescription rates and other billing aberrations, could track prescription patterns in real-time to assess whether fraud is occurring. "It is like reading the receipt before you pay the bill--something most Americans do every day," he said.
To learn more:
- read the Associated Press story

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