Top Medicare Official: 'We Can and Should Do More' to Oversee Drug Plan
Stung by reports of risky and profligate prescribing by doctors and others, a federal health official promised Monday to revamp the way Medicare scrutinizes its massive prescription drug program for seniors and the disabled.
Jonathan Blum, director of Medicare, told a Senate panel that his agency needs to do more to search for fraud and abusive prescribing, problems flagged recently by ProPublica and by government analysts.
Among the steps Blum said his agency plans to take:
- Require that all providers who write prescriptions to Medicare patients be enrolled in Medicare. That means they must verify their credentials and disclose if they’ve been disciplined or criminally convicted.
- Push Medicare’s high-paid fraud contractor to ramp up searches for prescribers with troubling patterns and refer more cases to law enforcement.
- Give private insurance plans that administer the drug program information about suspect pharmacies and providers, and, for the first time, allow them to limit or reject payments to them. Currently, the plans must pay for prescriptions written by all providers unless they’ve been kicked out of Medicare.
- Work with Congress on legislation that would restrict patients who are suspected of "doctor shopping" to obtain painkillers. Medicare had previously opposed such a step.
Blum’s pledges were met with skepticism by Sen. Tom Coburn of Oklahoma, who noted that Medicare doesn't have a good record of following through on promised reforms. Coburn, ranking Republican on the panel, said he wondered whether the committee would be sitting in the same place a year from now asking why officials had not acted.
"People are going to continue to die, right, under this program, and we’re going to put out rules in the fall?" he said at one point when Blum discussed making some changes later this year. "Why wouldn’t we put out rules now?"
Coburn, who is also an obstetrician, demanded that Blum submit written progress reports every three months and said they would be made public.
The hearing followed a ProPublica investigation published last month that found Medicare had failed to use its own records to flag doctors who prescribed thousands of dangerous, inappropriate or unnecessary medications.
One Miami psychiatrist, for example, wrote 8,900 prescriptions in 2010 for powerful antipsychotics to patients older than 65, including many with dementia. A black-box warning on the drugs says they should not be used in such patients because it increases their risk of death. The doctor said he'd never been contacted by Medicare.
ProPublica also found that many of the top prescribers of the most abused painkillers had been charged with crimes, convicted, disciplined by their state medical boards or terminated from Medicaid. Nearly all remained eligible to prescribe in Medicare.
At the time, Blum told reporters it was not Medicare's responsibility to second-guess doctors and that any questions should come from the private insurance plans.
But facing the committee Monday, Blum stated, "Clearly we can and should do more."
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