Bloomberg News

Drug Abusers Get Narcotics Through Medicare, Senators Say

October 04, 2011

(Adds Medicare response in seventh paragraph.)

Oct. 4 (Bloomberg) -- Disabled and elderly drug abusers may be costing taxpayer-funded Medicare almost $150 million a year by convincing doctors to write prescriptions for oxycodone and other narcotics, a government report found.

About 170,000 patients in Medicare, the federal health program for the elderly and disabled, acquired often-abused drugs from at least five doctors each in 2008, according to a report issued today by Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper, a Delaware Democrat, and the panel’s senior Republican, Scott Brown of Massachusetts.

Taxpayers subsidized multiple prescriptions of hydrocodone, fentanyl, oxycodone and other narcotics at a cost of $148 million in 2007, according to the report. The senators said the U.S. Centers for Medicare and Medicaid Services should restrict seniors shown to “doctor shop” for prescriptions from accessing such drugs.

“Beyond the fraud and abuse, taxpayer dollars are potentially being used to fuel the illicit prescription drug trade,” Brown said in a statement. Some Medicare patients got prescriptions from more than 80 different providers, he said.

Carper’s panel held a hearing on the issue today.

Brian Cook, a spokesman for the Centers for Medicare and Medicaid Services, didn’t immediately respond to an e-mail seeking comment. Jonathan Blum, CMS deputy administrator and director of the Center for Medicare, will testify at the hearing.

‘Not Necessarily’ Abuse

The Medicare agency told the Government Accountability Office, which prepared the report for Carper and Brown, that “high utilization of pain medications is not necessarily an indication of abuse.” The findings might instead be evidence of “poorly coordinated care in the treatment of pain symptoms,” the agency said.

Medicare administrators disagreed with a recommendation in the report that some patients be restricted from accessing drugs. Instead, analysis of drug utilization could be used to curb abuse, the agency said.

“We support solutions that will retain beneficiary access to care,” the agency wrote in a response to the findings.

About 120,000 of the drug abusers were eligible for Medicare because of a disability, rather than their age, according to the report.

People who qualify for Social Security disability benefits for two years or more become eligible for Medicare. Victims of amyotrophic lateral sclerosis, known as Lou Gehrig’s Disease, or permanent kidney failure are also eligible for the program.

Expanding Medicare

About 19 percent of people enrolled in Medicare’s drug benefit are eligible because of disabilities, the report found.

The government said yesterday in a regulatory filing that it would expand Medicare’s $62 billion drug program to cover benzodiazepines for mental illness and barbiturates used as sedatives. Both are commonly abused, regulators said.

Private insurers who provide drug coverage under Medicare, such as UnitedHealth Group Inc., based in Minnetonka, Minnesota, Humana Inc. of Louisville, Kentucky, and Coventry Health Care Inc. in Bethesda, Maryland, should try to “identify and prevent waste and clinical abuses/misuses” of the drugs, the government said in its filing.

Coverage for the two classes of drugs will cost taxpayers about $1.9 billion from 2013 to 2018, according to the filing. The coverage is required by a law passed in 2008 and signed by former President George W. Bush.

--Editors: Adriel Bettelheim, Steve Walsh

To contact the reporter on this story: Alex Wayne in Washington at awayne3@bloomberg.net.

To contact the editor responsible for this story: Adriel Bettelheim in Washington at abettelheim@bloomberg.net.


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