Current Weather
The Spy FM

Medicare Officials Seek Authority To Ban Harmful Prescribers

Filed by KOSU News in Health.
January 7, 2014

Medicare plans to arm itself with broad new powers to better control — and potentially bar — doctors engaged in fraudulent or harmful prescribing, following a series of articles detailing lax oversight in its drug program.

The Centers for Medicare and Medicaid Services described the effort Monday in what’s known as a proposed rule, the standard process by which federal agencies make significant changes.

Two of the changes mark a dramatic departure for the agency, which historically has given much higher priority to making medications easily accessible to seniors and the disabled than to weeding out dangerous providers of health care.

For the first time, the agency would have the authority to kick out physicians and other providers who engage in abusive prescribing. It could also take such action if providers’ licenses have been suspended or revoked by state regulators or if they were restricted from prescribing painkillers and other controlled substances.

And the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program, known as Part D, even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people with Part D coverage. This would require them to verify their credentials and disclose professional discipline and criminal history.

The changes would take effect Jan. 1, 2015. As part of the process, CMS will accept public comments until March 7 and could revise the proposals based on the feedback.

Several of the proposed changes address failings detailed by a ProPublica investigation last year.

In December, NPR and ProPublica ran a story about how Medicare’s system of fighting fraud is so convoluted and poorly managed that scams flourish and millions are wasted.

Reporters analyzed Medicare’s prescribing data to spot doctors who prescribed in very different ways than their peers — for example, by choosing drugs that were risky or costly, or in ways that suggested fraud.

On Monday, Medicare proposed giving its outside fraud contractor the ability to more easily investigate suspicions of fraud.

Currently, the contractor cannot directly access patient medical charts to assess whether the patient actually saw the doctor or had a condition that warranted the medication. The contractor must go back to the insurers, which then request the records from doctors or pharmacies.

Under the rule change, the contractor would be given the power to access the records directly. The inspector general of the Department of Health and Human Services has repeatedly pressed Medicare to make this change.

In a blog post, Jon Blum, the principal deputy administrator for CMS, said his agency is serious about fighting fraud and abuse in Part D.

“CMS strives to ensure that beneficiaries have the medications they need while at the same time is being vigilant to safeguard the program from inappropriate use,” Blum wrote. [Copyright 2014 ProPublica]

Leave a Reply

5AM to 9AM Morning Edition

Morning Edition

For more than two decades, NPR's Morning Edition has prepared listeners for the day ahead with two hours of up-to-the-minute news, background analysis, commentary, and coverage of arts and sports.

Listen Live Now!

9AM to 10AM The Takeaway

The Takeaway

A fresh alternative in morning news, "The Takeaway" provides a breadth and depth of world, national and regional news coverage that is unprecedented in public media.

View the program guide!

10AM to 11PM On Point

On Point

On Point unites distinct and provocative voices with passionate discussion as it confronts the stories that are at the center of what is important in the world today. Leaving no perspective unchallenged, On Point digs past the surface and into the core of a subject, exposing each of its real world implications.

View the program guide!

Upcoming Events in your area (Submit your event today!)

Streaming audio and podcasts

Stream KOSU on your smartphone

Phone Streaming

SmartPhone listening options on this page are intended for many iPhones, Blackberries, etc. with low-cost software applications available to listen to our full-time web streams, both News on KOSU-1 and Classical on KOSU-2.

Learn more about our complete range of streaming services

We're perfecting the patient experience - Stillwater Medical Center