Medicare's popular prescription program has an unsavory underside. It's an easy target for drug abusers seeking to feed their own addictions or sell painkillers for profit, congressional investigators said in a report released Tuesday.
The Government Accountability Office found that about 170,000 Medicare recipients each received prescriptions from multiple doctors for 14 frequently abused medications in 2008. Not counting related charges for office visits, the cost to the taxpayer-supported program amounted to $148 million.
Abuse of prescription medications is a fast-growing drug problem, particularly entrenched among teens and young adults. Sen. Tom Carper, D-Del., who requested investigation, said Medicare has a responsibility to not make things any worse.
"We have a moral imperative to make sure the public health system is not used to subsidize and intensify a public health crisis," Carper said at a hearing of the Homeland Security and Government Affairs subcommittee on federal financial management.
Medicare officials say they face legal limitations in what they can do to stop the abuse, although they recognize the problem and have adopted new strategies to confront it.
The investigation found brazen conduct indicating that drug abusers have little to fear from exploiting Medicare.
One 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. Investigators reported the 48 worst abusers to Medicare's fraud unit.
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.
The drug abuse problem might appear relatively minor measured against such statistics, but it can't be dismissed, said Sen. Scott Brown, R-Mass. "Though the percentage is small, we are still talking about 170,000 people abusing the system," he said. The 170,000 accounted for less than 2 percent of all the Medicare recipients who received prescriptions for the 14 frequently abused drugs.
All types of insurance plans confront prescription abuse. Obtained from unwitting doctors, narcotics, tranquilizers, stimulants, and sedatives 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," GAO investigators said.
Still, Medicare officials say they don't have the power to make that change. The prescription program, "in its current form, cannot restrict beneficiaries to a single physician or pharmacy," said Jonathan Blum, a top Medicare administrator. Instead Medicare wants the private insurance plans that deliver the prescription benefit to identify abusers.
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 found the worst abuse among 600 Medicare beneficiaries, each getting prescriptions from more than 20 doctors. One went to 87 prescribers. Painkillers hydrocodone and oxycodone were involved in more than 8 out of 10 cases of doctor shopping identified by investigators
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 incomes. Among the worst abusers, many had criminal records.
Medicare said it recognizes the need to prevent prescription abuse and is working on a range of counter-measures.
But GAO's Gregory Kutz was unimpressed. "I see a hole in the comprehensiveness of the fraud deterrent plan," he told senators. "You've got to have some consequences at the end of the day for people. That might deter them."