Current Medicare law has allowed doctors not enrolled in the program to frivolously prescribe medicine to patients enrolled in the program and has provided a breeding ground for fraudulent and harmful prescribing. The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed to tighten regulations on Medicare doctors.
ProPublica reported on Medicare’s “lax oversight” which was supposed to ease the prescribing of medications to the elderly and disabled. If enacted, the proposed rule would allow the CMS to bar doctors who engage in reckless and abusive prescribing from accepting Medicare payments. The CMS would also have the power to act if a provider’s license has been suspended or revoked or if barred from prescribing narcotic-based medications.
Outside of extended power to regulate abusive doctors, the provision in Medicare Part D that allowed them to get away with abusive prescribing practices will be tightened. There are 36 million people under Medicare Part D, and the new provisions would require doctors to formally enroll should they wish to continue prescribing medicine to these specific patients. Upon deeper investigation, some of the doctors were found to have had criminal backgrounds, lost medical licenses, or termination from some Medicare programs.
Part D’s annual costs to taxpayers are about $60 billion with much of it wasted on expensive and inappropriate medications, and fraud. Poor management and regulatory complications make it easy for people to defraud Medicare. Provider’s information can be stolen and used by a criminal party to acquire prescription drugs. All that’s needed is a forged signature.
Ernest Bagner was a psychiatrist in Hollywood, CA whose identity had been stolen. Many of the forgeries were under the name’s of patients that Bagner had never seen. He suspects that the crimes were part of a criminal drug network. “These people make more money off my name than I do,” he said.
To combat this onset of fraud, a provision in the new rule would allow Medicare’s outside fraud contractor to better investigate fraud. To accomplish this, the contractor would be given power to directly access patient medical charts. Before, the contractor had to go through the convoluted process of sending requests through the insurers to doctors and drug stores.
Some on Capitol Hill announced their support of the Medicare anti-fraud proposal. Yesterday, Sens. Tom Carper (D-Del.) and Tom Coburn (R-OK) gave their support because of the positive financial outcomes of the proposal. “For years, Medicare has lost millions of dollars due to fraudulent prescriptions for painkillers and other drugs,” said Carper.
“Health care fraud is a problem of growing concern in the U.S. and every effort should be made by the government and healthcare providers to ensure that taxpayer funds are not being wasted,” commented Christopher Paulos, an attorney with the Levin, Papantonio law firm who practices in the areas of qui tam or whistleblower and False Claims Act litigation. “These recent proposed rules are an effort to improve the oversight that Medicare can perform on health care providers accepting payment from the government.”