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‘Doctor-shopping’ found in Medicare drug program, GAO warns

At least 170,000 Medicare recipients used the program's prescription drug plans to “shop” for dangerous amounts of controlled narcotics in 2008, according to a new Government Accountability Office report.

Loopholes in the Medicare Part D program make it fairly simple to get prescriptions from multiple doctors without them knowing about each other. The result is $148 million per year in fraudulent prescription drug costs, most of which are shouldered by taxpayers, the report says.

The Drug Enforcement Administration defined doctor shopping as receiving prescriptions from five or more medical practitioners for the 12 classes of frequently abused controlled substances and two classes of frequently abused non-controlled substances.

“There are intricacies to Part D, but mostly it's a blank check,” said Largo pharmacist Larry Golbom, who hosts a radio show on prescription drug abuse. “The ramifications for a program that isn't really monitored are not a surprise.”

The GAO report suggests that the Centers for Medicare & Medicaid Services place restrictions on identified drug shoppers, but CMS spokesman Tony Salters said that agency officials are looking at other solutions.

“CMS' strategies include boosting health information technology and adopting electronic health records to keep a closer eye on Part D recipients,” he wrote in an e-mail.

He said the agency took part in a recent hearing on the issue and also hopes to prevent fraud by sharing data with law enforcement groups.

The GAO report says that many of the abusers were not seniors, but were younger people who receive Medicare because of disabilities.

There could be legitimate reasons for getting prescriptions from multiple practitioners, such as receiving care from different specialists, the report says.

In one particularly egregious case, a Medicare user obtained prescriptions from 87 doctors in one year.

---Health News Florida is an independent online publication dedicated to public-service journalism. Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.