A Florida massage therapist ordered 3,756 prescriptions filled by Medicare’s drug plan in 2009. The cost: $183,132.
The unidentified masseuse was among 2,780 professionals who didn’t have the authority to prescribe medication and nonetheless ordered drugs for Medicare patients, according to a review (PDF) last year by the Health and Human Services Department’s Office of Inspector General. The tally included 713 dietitians, 398 athletic trainers, 240 massage therapists, and 20 veterinarians, among others. Medicare plans and patients paid more than $5 million for the medications. The report found 7,679 prescriptions for frequently abused drugs such as oxycodone, written by people with no prescribing authority.
The government is planning to keep a closer watch on those prescription pads. In a new regulation finalized on Monday, the Centers for Medicare and Medicaid Services (CMS) will require that anyone writing a prescription to be paid by the drug plan, known as Part D, be enrolled in the Medicare program. The additional level of scrutiny apparently has not been required before.
Medicare drug plans, which are run by private insurers, will now have to deny pharmacy claims if they don’t have the ID of a valid prescriber. ”The overriding purpose of these provisions is to help ensure that Part D drugs are prescribed only by physicians and eligible professionals who are qualified to do so under state law and under the requirements of the Medicare program,” CMS wrote in its final rule (PDF) document, which runs 487 pages. The change will take effect on June 1, 2015.
The regulation covers some other ground as well. Altogether, CMS expects the reform to save $1.6 billion over the next 10 years. It may seem baffling that the agency didn’t take action sooner. Medicare’s drug plan, known as Part D, was created in 2006. There’s a rich literature on the fraud it made possible while helping 52 million elderly or disabled Americans afford medication.
In theory, Medicare will be able to more carefully screen people ordering drugs through the $62 billion-a-year program. Noting that some doctors with suspended licenses have been able to write prescriptions paid for by Medicare, the agency wrote, ”we believe we can better address these and similar vulnerabilities by verifying the credentials of prescribers.”
Even when it does screen doctors in its fee-for-service program, Medicare’s record of avoiding fraud is spotty, to put it mildly. The agency has been considered “high risk” for fraud and abuse by the Government Accountability Office for almost a quarter century—half its history—because of its size, complexity, and vulnerability to making improper payments.
Not filling prescriptions written by massage therapists won’t solve those problems, but it’s a small step in the right direction.