The American Recall Center/Medicare Part D
by – Sheri de Grom
How can one doctor continue to write an excessive amount of prescriptions, and have them filled—151 times more than the average doctor’s tally for all Medicare patients—and not have it raise a red flag? The cost to the government was $9.7 million.
Pro Publica’s investigative reporters analyzed four years of Medicare prescription drug data and examined the prescriptions of all health professionals across specialties. It examined all prescriptions—1.7 million in 2010 alone—not just those in general-care specialties or mostly urban areas.
Medicare’s prescription drug program was launched in 2006 and now accounts for one
in four prescriptions dispensed, according to the Inspector General. Last year the government spent $62 billion subsidizing the drugs of 32 million people.
Medicare has failed to protect patients from doctors and other health professionals who prescribe large quantities of potentially harmful, disorienting or addictive drugs. It’s impossible to maintain medication safety for the Medicare population when a government agency turns a blind eye to the needs to a vulnerable population.
I rarely agree with anything Senator Tom Coburn (R) of Oklahoma comments on and his voting record reflects an extreme right approach. However, I do agree with his statement, “No one wants Medicare telling doctors which drugs to prescribe. But, the government does have a responsibility in preventing fraud and abuse.”
The Office of the Inspector General of the Department of Health and Human Services has repeatedly directed the Center for Medicare officials to be more vigilant. Yet the agency has rejected several key recommendations as unnecessary or over-reaching.
After I retired from government, an advertisement for a Chief Financial Officer for a group of nursing homes in North Carolina caught my eye. I knew from previous investigations that the abuse of pharmaceuticals as money-makers was wide-spread but I had no idea how bad it was in the civilian sector until I accepted this position.
The prescribing practices I found the most deplorable were for profit margin and not for the benefit of patients.
A private practice psychiatrist visited the facility once a month and fraudulently annotated in the patient charts to reflect he had assessed the patients for the high levels of pharmaceuticals he prescribed. Each note in a patient’s medical chart was billed as an office visit by the doctor, resulting in a hundred or more office visits per day. The doctor visited five nursing homes each month and he billed for 300 patients per nursing home. This doctor did not need to maintain an office, he made his fortune via fraudulent billing.
Pharmaceuticals had the largest profit margin of any other department at the group of nursing homes where I was employed and anti-psychotics were prescribed two to one over any other drug.
I hadn’t been hired by the nursing homes’ corporate office to investigate pharmacy, Medicare, or other types of abuse. I’d been hired to look for new sources of revenue and to collect back debt.
I couldn’t allow the patient population to receive excessive sedating drugs. The patients included: the elderly, veterans, the disabled needing extensive physical therapy and hospice patients. It’s no wonder the patient population seemed more confused, became agitated and fell often creating even more work for an industry that’s routinely under-staffed.
Thankful, for many reasons, I don’t have Medicare Part D for my prescription coverage and I’m grateful a portion of my health-care coverage has stayed almost level. I’m still able to use my same independent pharmacy where we’ve had prescriptions filled since we moved to our home eight years ago.
It’s no wonder medications are so costly today. The United States is the only country in the civilized world that charges its consumers the cost of research and development for every brand name drug sold.
Additionally, Congress has served up a blank check to pharmaceutical companies for Medicare Part D. It prohibits Medicare from negotiating with companies for lower prices. Medicare places no cap on the cost of medications they approve and these results in the patient having a higher co-payment.
Medicare might benefit the patient if it allowed the same negotiating of payment policy with physicians and other healthcare services.
What do you think? Will Medicare Part D be what you need when it’s your turn to need pharmaceutical coverage?
Congress and Medicare gave the pharmaceutical companies a blank check with our tax dollars held for ransom. Why is this okay with Congress, the Presidential Administration and the Supreme Court? This is not equal opportunity, it’s not safe medicine and it’s not justice!
Thank you for reading with me. I always appreciate you support. The month of October marks the calendar as “Talk About Your Medicines” month. I’m honored that www.recall.com/community asked me to be an extension of their campaign. Please visit their site.