Doctors Overprescribe Dangerous Drugs to Medicare Patients

Despite increasing awareness of prescription drug abuse over the last several years, too many Medicare patients have been prescribed potent controlled substances, and certain doctors regularly write these prescriptions even though they’ve been scrutinized by medical boards.

A study by the investigative news site ProPublica for 2012 found that Medicare covered nearly 27 million prescriptions for powerful painkillers and stimulants with the highest potential for abuse and dependence. That’s an increase of 9% from 2011. In that period, Medicare prescriptions overall increased 5%.

The reporters found that:

  • Twelve of Medicare’s top 20 prescribers of Schedule II drugs in 2012 have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices. (Schedule II drugs have a high potential for abuse and can lead to severe psychological or physical dependence. They are considered dangerous and include, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.)
  • In 2012, 269 providers wrote at least 3,000 prescriptions for Schedule II drugs. (Florida led the country with 52 providers. Tennessee had 25, and North Carolina, Ohio, Georgia, Pennsylvania, Alabama and Kentucky each had more than 10.)
  • About 1 in 5 doctors who wrote at least 3,000 prescriptions for Schedule II drugs have faced some kind of sanction or investigation.
  • Medicare did not analyze its own data or take action against providers whose patterns were troubling, even if they had been charged with Medicare fraud or kicked out of state Medicare programs.

The No. 1 prescriber of Schedule II drugs in the ProPublica report was Dr. Shelinder Aggarwal of Huntsville, Ala., who wrote more than 14,000 such prescriptions in 2012. His controlled substances certificate was suspended by the state medical board in 2013, and he subsequently surrendered his medical license.

Aggarwal was a pain medicine specialist who consistently had shown up in Medicare data as a top prescriber of narcotics. By 2012, more than 8 in 10 of his Medicare patients received at least one prescription for a Schedule II drug. Other pain-specialty doctors in Alabama wrote prescriptions for Schedule II drugs to fewer than 4 in 10 of their patients.

In many cases, Aggarwal prescribed oxycodone, which, as described in our blog, “The Costs of Overdosing on Prescription Painkillers,” is a powerful painkiller generally meant to address short-term problems, or for palliative care for the dying. Taken inappropriately, it presents a risk not only of addiction, but tolerance that leads to taking increasingly higher doses. An overdose can result in loss of consciousness and the ability to breathe.

Only after pharmacies near Aggarwal’s office alerted the Alabama Board of Medical Examiners to his prescribing habits did the agency investigate, making undercover visits to his office and videotaping him prescribing drugs without examining patients.

“If you paid $1,200 in cash, [Aggarwal’s office] would put a VIP stamp on your medical records and you didn’t ever have to have an appointment,” Larry Dixon, the board’s executive director, told ProPublica.

Prescribing a lot of Schedule II drugs can indicate a doctor is running a pill mill, according to Dr. Andrew Kolodny, chief medical officer of Phoenix House, a drug treatment provider. He told the reporters that government regulators should monitor prescribing patterns better and intervene if they appear unusual.

“We wait ’til these doctors kill people,” he said. Kolodny is founder of Physicians for Responsible Opioid Prescribing, which advocates for tighter regulation of painkillers.

Medicare’s drug program, called Part D, covers about 38 million seniors and disabled people. It pays for more than 1 in 4 four prescriptions dispensed in the U.S. “Concerns about oversight of controlled substances,” according to ProPublica, “date back to at least 2011, when the Government Accountability Office highlighted abuse of opioids in Part D and called on Medicare to take action.”

The data from 2012, the reporters showed, indicate that the increase in prescriptions of controlled substances was underway before these initiatives took hold. In the last year, Medicare has begun to use prescribing data to identify potentially problematic doctors, as have some state medical boards. But not until mid-2015 will the feds have the authority to remove doctors from Medicare if they abuse their prescription-writing authority.

Limits are set on prescribing Schedule II drugs, which require written prescriptions that cannot be refilled. (Doctors may give patients a 90-day supply by writing additional prescriptions during a visit.) In contrast, prescriptions for Schedule III drugs, which are somewhat less addictive, can be phoned in and refilled as many as five times.

Tracking physician prescribing habits falls mostly to state medical boards and Medicare. Law enforcement agencies enforce the rules for controlled substances, and, typically, they have relied on complaints, rather than data analysis, to initiate investigations.

Last year, ProPublica reported that Medicare wasn’t proactive in analyzing its prescribing data or taking action against providers with troubling records, even if they had been charged with Medicare fraud or kicked out of state Medicaid programs. Astonishingly, most of Medicare’s top prescribers of OxyContin in 2010 had faced legal or disciplinary actions, but many retained the ability to prescribe in Part D.

In September, Medicare sent 760 letters to doctors who disproportionately prescribed Schedule II drugs for their medical specialty and state in the hope of prompting them to examine their prescribing habits and make changes. But, really, without clear, serious consequences how likely are these shameless prescribers to change their revenue-generating ways?

Medicare has referred the names of 71 prescribers to the inspector general of the U.S. Department of Health and Human Services, and one to a state medical board, for possible investigation.

If you want to see how your state stacks up for doctors who prescribe these dangerous drugs, link here to ProPublica’s Prescriber Checkup site.

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