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May 13, 2013

What drugs is your doctor prescribing? New database sheds light

Daily Briefing

ProPublica over the weekend unveiled its "Prescriber Checkup," a database that compiles 2010 Medicare prescription data for 1.7 million health care providers.  

To create the database, researchers and reporters for the investigative news publication culled through "hundreds of millions of records" of Medicare Part D data from 2007 to 2010 obtained through the Freedom of Information Act. They built a searchable database of physicians' identities and prescription patterns, prescription trends by state, top-prescribed drugs, and other Medicare Part D figures.

The database reveals that in 2010 alone, Medicare Part D accepted 1.1 billion claims through 1.7 million prescribers. The total retail price of those prescriptions was $77.7 billion. However, half of all of those prescriptions were written by just 3% of providers.

OIG: Insurers, CMS failing to police drug claims

Overall, the ProPublica investigation revealed that many health care providers have been improperly prescribing large quantities of drugs to U.S. patients with little oversight from the government.

According to CMS, oversight of Medicare Part D falls to the health plans that administer the program. However, Medicare does not allow those insurers to reject drug claims, making it "nearly impossible" for insurers to discern if beneficiaries are being prescribed the wrong drug or too many drugs for their conditions, according to ProPublica.

Insurers can refer suspicious cases to Medicare's fraud contractor, but a January 2013 HHS's Office of the Inspector General (OIG) report found that these contractors rarely generate their own investigations or prevent further fraud. A 2011 report also found that Part D has no infrastructure in place to ensure that the drugs being prescribed are all FDA-approved.

The office has "repeatedly criticized CMS for its failure to police" Part D, yet the agency has "rejected several key recommendations as unnecessary or overreaching," ProPublica reports.

Providers who have been charged with crimes continue to prescribe through Part D

ProPublica also notes a lack of oversight over individuals allowed to prescribe medications through Medicare Part D:

  • In 2007 alone, Medicare Part D covered $1.2 billion worth of drugs prescribed by unidentified providers, ProPublica reports.
  • "Half of Medicare's top 20 prescribers of OxyContin in 2010 have also been criminally charged, convicted or settled fraud claims, or have been disciplined by their state medical boards, records show," according to ProPublica. Eight of the top 20 prescribers of the highest-dose oxycodone pills in 2010 have also been charged, convicted, or barred from prescribing drugs, but only one of them has been barred from Medicare Part D.

Former CMS administrator Mark McClellan said in an interview with ProPublica that Medicare should at least be able to halt payment for prescriptions written by doctors facing fraud charges. "That's the kind of thing ... you ought to be able to find a way to deal with," he said (Weber et al., ProPublica/Washington Post, 5/11).

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