OIG to CMS: Watch for problem prescribers

The Office of Inspector General has asked the Centers for Medicare & Medicaid Services to take a series of actions to thwart inappropriate Part D prescribing.

According to a new report from the OIG, more than 700 general-care physicians wrote potentially dangerous and unnecessary prescriptions for elderly and disabled patients in 2009. Out of the 87,000 doctors' prescribing records investigated, these 736 cases stood out as "extreme outliers," due to doctors' prescribing high percentages of Schedule II and III drugs and prescribing high amounts of drugs per beneficiary. Out of this group, 108 physicians ordered an average of 71 or more prescriptions per beneficiary, compared to the national average of 13, Bloomberg BNA reported

In addition, the OIG flagged another 2,200 doctors as writing unusually high numbers of prescriptions per patient, brand-name drugs, painkillers and other addictive drugs, or for odd patterns in their choice of pharmacies. For example, one Illinois doctor had prescriptions filled by 872 pharmacies in 47 states and Guam, the Washington Post reported, adding that internal medicine and family physicians, on average, had prescriptions for all their Medicare patients filled by 52 pharmacies.

CMS, while acknowledging that some of this activity could be legitimate and ensuring that it did not want to impede beneficiaries' access to needed medications, agreed to abide by the following OIG recommendations:

  • Work with the Medicare Drug Integrity Contractor to strengthen oversight of physician prescription behavior.
  • Issue guidance for both Part D plan sponsors and physicians on appropriate prescribing behavior.
  • Review the prescription orders for the 736 physicians identified by OIG.

To learn more:
- read the article from the Washington Post
- see the post from Bloomberg BNA
- see the report (.pdf) from the OIG

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