Medicare Moves to Ban Doctors With Dangerous Prescribing Practices

Last month, we summarized an investigative series published on about the wasteful and risky practices of Medicare’s prescription drug program, forged by carelessness, incompetence, political agendas or a combination.

Earlier this month, ProPublica published a story that points to an increasing awareness of the problems and – remarkably! – institutional resolve to address them.

“Medicare plans to arm itself with broad new powers to better control – and potentially ban – doctors engaged in fraudulent or harmful prescribing,” ProPublica wrote, “following a series of articles by ProPublica detailing lax oversight in its drug program.”

The U.S. Centers for Medicare and Medicaid Services (CMS) is proposing to exercise authority to ban physicians and other providers who engage in abusive prescribing. It would be able to do so as well if somebody’s license has been suspended or revoked by state regulators, or if he or she was restricted from prescribing painkillers and other controlled substances.

CMS also wants to close a loophole that allows doctors to write prescriptions for Medicare patients even if the providers aren’t enrolled in the drug program known as Part D. The new rule would make doctors and other providers formally enroll if they want to write prescriptions for the 36 million people in Part D. Their credentials would have to be verified and their professional disciplinary actions and criminal histories disclosed.

ProPublica calls these measures “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.”

The changes would become effective next year. CMS is accepting public comments until March 7 and could revise the proposals based on the feedback. CMS will accept public comments until March 7, and might revise the proposals based on them. If you would like to weigh in, click here.

As it now stands, Medicare and the private insurers that run Part D don’t vet providers who write prescriptions, even the ones ProPublica identified last month as being out of financial control and costing taxpayers millions every year. They don’t vet the ones who prescribe high volumes of inappropriate drugs. As noted in the series, ProPublica found that some doctors had been criminally charged or convicted, had lost medical licenses or had been terminated from state Medicaid programs serving the poor.

Here are some other measures the CMS proposal would take:

  • Enable its outside fraud contractor to investigate suspicions of fraud more easily. Currently, the contractor cannot directly access patient medical charts to assess whether the patient actually saw a doctor or had a condition that warranted a medication. The contractor must get this information from the insurers, which then request the records from doctors or pharmacies.
  • Whittle down its list of “protected drug classes,” vital drugs for which insurers cannot impose restrictions on use. The agency wants to remove antidepressants and immunosuppressant drugs from the list, giving insurers more latitude to require patients receive prior approval before receiving certain brand-name medicines.
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