Sen. Tom Carper, D-Del., who chaired the hearing, cited two new government reports on the program, known as Part D, from the inspector general of the US.Department of Health and Human Services. The first, issued last week, found more than 700 general-care physicians with extremely questionable prescribing patterns, including prescriptions that were filled at hundreds of pharmacies across dozens of states.
On Monday, a second report said Medicare paid for more than 417,000 prescriptions that appeared to have been written by massage therapists, dieticians and other professionals who don't have authority to prescribe drugs.
Blum said his department had already made changes to the popular prescription plan, such as requiring all prescribers to have a national health identification number to reduce fraud.
Coburn reserved his harshest criticism for Medicare's oversight of its fraud contractor, Health Integrity LLC, saying the Maryland firm does little for the $14 million it receives each year. "I'm pretty disgusted," he said. "My hope is that you'll ride the contractors."
Alanna Lavelle, the director of special investigations for WellPoint Inc., a large national insurer, also directed criticism at the fraud contractor. She said WellPoint had referred more cases of prescription fraud to the contractor than all but one insurer. But, she said, "We are never advised as to what type of action is ever taken."
A Health Integrity representative referred a call for comment back to CMS.
Coburn also sparred with Blum over what steps Medicare takes to check out the doctors and other health professionals who are prescribing to the 32 million elderly and disabled people in the program.
Blum acknowledged that Medicare does not always know about state medical board disciplinary actions and doesn't always tell insurance plans when a provider has been kicked out of Medicare.
"That’s a vulnerability that I concede that we need to do a better job," he said.
The hearing, which focused largely on the overprescribing of painkillers in Part D, also included testimony from representatives of the inspector general's office and the Drug Enforcement Administration.
Blum said he expected resistance to some of the proposed changes because they will require more paperwork and oversight.
"It will create more friction that you will hear about from the physician community, from pharmacies, from beneficiaries themselves," he said. "The program will need your support once that friction starts."
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