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Medicare patients 'doctor shopping' for pain killers

By pathos, Oct 14, 2011 | Updated: Oct 14, 2011 | | |
  1. pathos
    Probe: Drug abusers exploiting Medicare benefit

    WASHINGTON (AP) - Drug abusers are exploiting Medicare prescription's benefit to score large quantities of painkillers, and taxpayers have to foot most of the bill, according to a new report by congressional investigators.

    About 170,000 Medicare recipients received prescriptions from multiple doctors for 14 frequently abused medications in 2008, the Government Accountability Office found in an investigation for the Senate Homeland Security and Governmental Affairs Committee. Medicare officials say they're limited in what they can do to stop the abuse.

    A Medicare recipient in Georgia got prescriptions for 3,655 oxycodone pills - more than a four-year supply of the painkiller - from 58 different prescribers. Another, in California, got prescriptions for a nearly five-year supply of fentanyl patches and pills from 21 different prescribers. Fentanyl is a very strong narcotic used to treat relentless cancer pain.

    The cost of the questionable prescriptions amounted to $148 million in 2008. Overall, taxpayers pay three-fourths of the cost of the Medicare prescription drug program, which covers some 28 million seniors and disabled people for about $55 billion a year.

    Prescription drug abuse is a growing problem for all types of insurance plans. Narcotics obtained with a prescription from unwitting doctors can feed a personal addiction, or be resold in a lucrative underground market. The doctors who write the scripts often don't realize their patients are visiting other physicians to get the same medications.

    The scam is known as "doctor shopping." And Medicare appears to be hamstrung in confronting it, the report concluded.

    Many private insurance plans and state Medicaid programs restrict patients who appear to be abusing drugs so they can only get narcotics from specific doctors and pharmacies. But Medicare officials told investigators that federal law does not allow the prescription program to limit the access of beneficiaries who appear to be abusing drugs.

    That leaves "little recourse for preventing known doctor shoppers from obtaining hydrocodone, oxycodone and other highly abused drugs," the report said.

    Sens. Tom Carper, D-Del., and Scott Brown, R-Mass., are seeking ways to tighten Medicare rules. Carper chairs a subcommittee holding a hearing on the problem.

    Using claim records, investigators illustrated how doctor shopping works: One unnamed Medicare beneficiary visited four doctors over 27 days to obtain a 150-day stock of oxycodone. The first doctor wrote a prescription for a 15-day supply, the second doctor for 20 days, and so on. The beneficiary made repeat visits to three of the four doctors.

    The investigation, first reported by The New York Times, found the worst abuse among 600 Medicare beneficiaries, each getting prescriptions from more than 20 doctors. Painkillers hydrocodone and oxycodone were involved in more than 8 out of 10 cases of doctor shopping identified by investigators, who referred several cases to Medicare fraud investigators.

    In the context of the program as a whole, the number of drug abusers is small. The 170,000 whose prescription-use patterns aroused suspicion accounted for less than 2 percent of all the Medicare recipients who received prescriptions for the 14 frequently abused drugs.

    Investigators attributed most of the cases of questionable behavior to younger beneficiaries, eligible for Medicare because of a disability and not their age. Nearly three-fourths of them also had low income.

    In its response to the investigators' findings, Medicare said it recognizes the need to prevent abuse of the prescription program and is looking for ways to best accomplish that.

    "This is getting old. I found out this AM that my state is now creating a database so all prescription records will be linked in my state among pharmacies and doctor's offices to combat this problem. Just another control put in place by the government because of people misusing a substance that I currently depend on. It also could impact doctors providing opiates to chronic pain patients. I follow the "opiod treatment agreement" with my doctor and stick with one doctor and one pharmacy. This adds fuel to the fire in Washington about cutting Medicare, another benefit I depend on due to disability. I highlighted the paragraph that applies".

    "It seems like every day there is some new damn probe into medicare or patients receiving pain killers and now they have linked both. All I can do is wait for the benefits I spent years obtaining to be axed for one reason or another. The government is on a witch hunt with narcotics and they seem to be able to impose regulations and rules regarding medicine with lightning speed. I wonder if they are exerting as much energy into regulating banks and the deceptive practices that they incorporate?"

    By RICARDO ALONSO-ZALDIVAR, Associated Press Published: Oct 4, 2011 at 7:50 AM PDT Last Updated: Oct 4, 2011 at 12:58 PM PDT


  1. squeezix
    This doesn't seem right to me, correct me if I'm wrong, but isn't Medicare strictly for the elderly (over 65) and retired. It's Medicaid that they are abusing.

    Either way it's big Pharma's fault, they never should have let the oxycodone cat out of the bag.
  2. pathos
    Medicare is generally for the elderly but is also for anyone receiving Social Security Disability benefits regardless of age. Like the story says, most of those abusing the privilege are disabled, younger people. If you get SSD (social security disability) you are required to use Medicare as a primary insurance unless you have enough money to buy private insurance. It is a godsend for someone like myself who worked as long as possible with a disability and then simply could not make it out the door. I am trying to find work closer to home that can accommodate my disability but there aren't enough jobs for people w/o disabilities at the moment.

    I haven't been in this system long enough to know exactly how they determine who gets what but it is based on the amount of time you have worked and how much money you have put into Social Security prior to becoming disabled. Then it usually takes years to get the benefits even with mounds of medical evidence. Some people can only get Medicaid which is State funded while Medicare is federally funded.

    That is why I took this story personally because I am considered to be in the bracket of young disabled people receiving medicare. I am a minority and if the trend of people getting medicare through disability and doctor shopping continues I worry that my benefits will be among the first cut when they start cutting medicare. Then I have to go back to medicaid which provided horrible health care where I live. And no Pain management specialists, that I know of, will accept it.
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