Medicare Part D Prescription Abuses Draw Scrutiny

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  • May 21, 2014
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Abuses in drug prescription practices for Medicare Part D patients got so bad, Medicare announced  May 19 it will watch providers like a hawk.  Under the plan, the Centers for Medicare & Medicaid Services (CMS) will compel physicians to join Medicare if prescribing for Part D patients, and the agency will expel physicians from Medicare if found to prescribe drugs in abusive ways.
Making providers join Medicare closes a loophole allowing some to prescribe drugs to Part D patients with little or no oversight.  Part D covers 37.5 million seniors and disabled patients and accounts for one in four prescriptions dispensed, costing $62 billion in 2012, ProPublica reports.  The news agency revealed last year that the agency’s failure to oversee Part D had “enabled doctors to prescribe inappropriate or risky medications, had led to the waste of billions of dollars on needlessly expensive drugs, and had exposed the program to rampant fraud.”
CMS gave providers until June 1, 2015 to either enroll in Medicare or formally opt out of Part D. If physicians fail to do so, Medicare will no cover drugs ordered for beneficiaries. According to ProPublica, most affected will be dentists and Veteran Affairs physicians, who prescribe to Part D patients while not being members. If they opt in, verification of government licenses and credentials, and a review of criminal histories will be made by the agency.

Brad Ericson
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Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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