Over 700 US doctors suspected of harmful excessive prescription practices – report

Questionable and potentially harmful prescriptions, costing the US government some $352 million, were prescribed for elderly and disabled patients by 736 general care physicians under the national insurance program Medicare, a new report revealed.

The 28-page report by the inspector general of the Department of Health and Human Services, titled ‘Prescribers with Questionable Patterns in Medicare Part D,’ identified some of the doctors’ prescriptions as “very extreme,” and concluded that the individuals need to be further investigated.

The report red-flagged the records of more than 2,200 doctors for either overprescribing drugs to individual patients, promoting brand-name drugs, painkillers and other addictive drugs, or using an alarmingly high number of pharmacies to dispense drugs.

A total of 87,000 general care physicians on the list in 2009 were reviewed, which is about half of all prescribing doctors in the program during that year. Moreover, 736 of those physicians were identified as “extreme outliers,” calling the legitimacy and necessity of the prescriptions into question.

In one instance, 24 doctors issued more than 400 prescriptions, including refills, for a single patient, while the average doctor writes about 13 prescriptions per patient, report said.

One doctor from Ohio went overboard in prescribing perceptions for more than a dozen patients. An Illinois doctor was flagged for having his prescriptions filled by 872 pharmacies in 47 states and Guam. In comparison, doctors have their prescriptions filled by 52 pharmacies on average.

The annual price tag paid by the government for these medications is massive, at a cost of $352 million to cover drugs ordered by flagged doctors.

One California doctor’s prescriptions cost Medicare $9.7 million – 151 times the cost of prescriptions ordered by an average doctor. The report also revealed that the doctor was supplied by two pharmacies that in the past were labeled as having questionable billing practices by the inspector general, the Washington Post reported.

Although some of the prescriptions may have been appropriate, “prescribing high amounts on any of these measures may indicate that a physician is prescribing drugs which are not medically necessary or that he or she has an inappropriate incentive, such as a kickback, to order certain drugs,” the report said.

The Senate Homeland Security and Governmental Affairs Committee is scheduled to hear a case on abuse in the Medicare Part D program.

“Strong oversight of the Medicare prescription drug program is critical for protecting patients from harm,” Sen. Thomas R. Carper (D-DE) and chair of the Senate Homeland Security and Governmental Affairs Committee told Washington Post in an email.

Medicare officials “should be using their data to make sure those practicing medicine are practicing medicine and not practicing a sham,” said Senator Tom Coburn (R-OK), who is an obstetrician.

The report calls on the Centers for Medicare and Medicaid Services (CMS), which oversees the program, to investigate the flagged doctors and improve the training of private insurers that oversee Part D to spot scams.
The Medicare agency responded by stating that it must find a way to proceed with the report’s recommendations while providing patients with needed drugs: “We must balance these efforts with ensuring that beneficiaries have access to the medicines they need,” a CMS spokesperson said in a statement.

The report is the latest investigation into oversight problems in Medicare Part D. A ProPublica report published in May revealed that doctors overprescribed drugs that were potentially harmful. Another study uncovered that insurers have paid for prescriptions that came from doctors who were barred by Medicare.

Coburn said the Medicare has previously been warned about its oversight problems: “This is incompetency and lack of somebody being held accountable.” 

Medicare is a national social insurance program administered by the US government. It guarantees access to health insurance for Americans 65 years of age and older, as well as people with disabilities. Medicare Part D came into effect in 2006, and deals specifically with prescription drugs. It accounts for about one of every four drugs distributed nationally. In 2012, it cost the government $62 billion to subsidize medications for 32 million people.