Transcript of Gregory Kutz’s testimony on GAO’s investigation into Medicare Part D prescription drug abuse

Transcript of testimony by Gregory Kutz, Director of GAO’s Forensic Audits and Special Investigations Unit, on Medicare Part D prescription drug abuse and fraud before Subcommittee on Federal Financial Management on Oct. 4, 2011:

“Mr. Chairman and Ranking Member Brown, thank you for the opportunity to discuss Medicare Part D. In 2009, I testified before this subcommittee on doctor shopping in Medicaid. Today’s testimony highlights the results of our investigation into doctor shopping in Medicare Part D.

“My testimony has two parts. First, I will discuss our findings. Second, I will discuss our recommendations.

“First, we found indications of doctor shopping for 14 classes of frequently abused prescription drugs, including Vicodin, Ritalin, and Oxycontin as examples.

“Specifically, 170,000 beneficiaries acquired the same class of prescription drug from five or more prescribers during 2008. This represents about 1.8% of the beneficiaries acquiring these classes of drugs, and they showed indications – as I mentioned – of doctor shopping.

“The cost of these drugs was about $148 million, which excluded the cost of office visits. We referred 48 of the most egregious of these cases to the Medicare Drug Integrity Contractor for further investigation.

“Our report documents the facts related to 10 individuals that were doctor shopping. Many of these individuals have prior criminal histories. This was not a random sample, and the results from these 10 cases cannot be projected to all 170,000 cases.

“Examples that you both mentioned from our work for these 10 cases include:

“A California man received a 1,758-day supply of fentanyl patches, which is a narcotic painkiller, from 21 different prescribers.

“A Georgia woman received a 1,679-day supply of oxycodone, also a narcotic painkiller, and other drugs from 58 different prescribers and 45 different pharmacies.

“A Maryland woman received a 1,450-day supply of oxycodone from 11 different prescribers.

“The graphic in your package, which I have in my hand here – looks like this – illustrates an actual case from our investigation. As you can see, between Sept. 8 and Sept. 19, this individual received three 30-day supplies of the painkiller hydrocodone. These prescriptions were obtained from three different prescribers and filled at three different pharmacies. In cases like this, the prescribers told us that they were unaware that their patients were receiving the same prescription drugs from other prescribers.

“Our recommendations to address doctor shopping are consistent with those used in the Medicaid program, as you mentioned Mr. Chairman, and also in the private sector.

“First, we recommend that CMS consider the use of a restricted recipient program. This program would limit known system abusers to one prescriber, one pharmacy, or both. Since abusers generally face no criminal consequences and will not be removed from Part D, this “lock-in” program provides a valid mechanism to protect taxpayer interests.

“Second, if a restricted recipient program is implemented, CMS should consider enhancing the sharing of information on these doctor shoppers between the drug plans. This is necessary to prevent abusers from circumventing controls by simply switching drug plans.

“Third and finally, because of CMS concerns about its legal authority to make these changes, we recommend that CMS consider seeking congressional authority as necessary to implement the recommendations.

“In conclusion, as you both mentioned, Medicare dollars are being used to finance prescription drug abuse in our nation. GAO is hopeful that Congress and CMS will use this report to improve the integrity and the safety of the Medicare Part D program.”



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  1. Pingback: GAO audit uncovers prescription drug fraud by Medicare Part D beneficiaries | What The Folly?!

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