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Capitol Connections Article [CMS] [06/27/2013] (copy)
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CMS Spends Millions on Invalid Prescriptions 

The Health and Human Services Office of the Inspector General has just released a report that shows the Centers for Medicare & Medicaid Services (CMS) is paying for thousands of prescriptions totaling millions of dollars in taxpayer money prescribed by individuals without prescribing authority. Click here to review the report.

To be covered under Medicare Part D, drugs must be prescribed in accordance with State law, which specifies the types of health care providers that have the authority to prescribe drugs in the State. Although these health care providers can vary by State, some types clearly do not have the authority to prescribe in any State. If drugs are being ordered for Medicare beneficiaries by individuals who do not have the authority prescribe, it raises concerns about the appropriateness of Part D payments and about patient safety.

A review of 2009 Part D payments nationwide showed that Medicare inappropriately paid for 72,552 prescriptions ordered by 14 prescriber types that clearly do not have the authority to prescribe in any State. The OIG selected these 14 prescriber types for review; they do not represent all types without the authority to prescribe. The 14 types included massage therapists, athletic trainers, and dental hygienists. None have the training necessary to prescribe drugs. In total, Medicare paid $5.4 million for prescriptions ordered by those prescriber types.  

An in-depth analysis of ten States revealed that Medicare Part D inappropriately paid for 344,714 prescriptions ordered by other selected types that did not have the authority to prescribe. In total, Medicare paid $26.2 million for drugs ordered by counselors, chiropractors, social workers, physical therapists, registered nurses, occupational therapists, and speech-language pathologists.

Notably, massage therapists ordered 12,082 prescriptions in 2009. Athletic trainers ordered another 8,795. Contractors ordered 2,827 prescriptions; these individuals complete home repairs or modifications to accommodate a health condition, such as wheelchair ramps. Others who ordered prescriptions paid by Part D included personal care providers (e.g., home health aides, chore providers, and companions), interpreters, transportation companies (e.g., taxis, private vehicles, and drivers), lodging companies, and veterinarians.

  • One Florida counselor ordered 2,912 prescriptions for 217 beneficiaries, which were filled at 103 pharmacies.
  • An Ohio social worker ordered 1,639 prescriptions, which were all filled at one retail pharmacy.
  • A registered nurse from California ordered 1,111 prescriptions, which were filled at a single retail pharmacy in New York.
  • An Illinois social worker ordered 1,345 prescriptions, which were filled at 149 pharmacies for 312 beneficiaries. Almost all of these pharmacies were part of the same national chain.

Pharmacists have an obligation to assure that all prescriptions are issued by an authorized prescriber.  Failing to verify that and subsequently submitting billings for medications to Medicaid or Medicare can result in audits as well as significant penalties.




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