BY RANDY ELLIS
A state agency has forwarded lists of the top 10 Oklahoma Medicaid prescribers of OxyContin, Xanax and six other pain and anti-psychotic medications to a U.S. senator concerned about fraud and abuse within the $317 billion federal program.
The Oklahoma Health Care Authority terminated three physicians from participating in the federal Medicaid program and is reviewing the status of 10 others after their names showed up on top 10 lists of physicians writing the most prescriptions for frequently abused pain and mood altering medications, The Oklahoman has learned.
U.S. Sen. Charles Grassley, R-Iowa, sent a letter to the authority last April requesting lists of the top 10 Oklahoma writers of Medicaid prescriptions for OxyContin, Xanax and six other pain and antipsychotic medications.
“The overutilization of prescription drugs, whether through drug abuse or outright fraud, plays a significant role in the rising cost of our health care system,” Grassley said in the letter to the Oklahoma Health Care Authority.
Grassley said in a letter to Human Services Secretary Kathleen Sebelius that he has been requesting records nationwide in an effort to identify “outlier” doctors who have issued prescriptions for certain drugs in much greater quantities than their colleagues.
“High rates of utilization are not necessarily indicative of wrongful behavior or health care fraud,” Grassley wrote. “But there can be no doubt that they merit scrutiny by your department.”
Nancy Nesser, pharmacy director for the Oklahoma Health Care Authority, said the agency reviews data like the information requested by Grassley on a regular basis and will review a doctor\’s performance if something seems out of line.
Writing a lot of prescriptions, alone, would not justify termination from the Medicaid program, she said. Doctors involved in certain specialties write a lot more prescriptions than others. For example, a doctor with a pain management practice might be expected to write a lot of prescriptions for OxyContin or Roxicodone, and a psychiatrist at a state mental hospital might be expected to write a lot of prescriptions of antipsychotic drugs like Abilify.
However, if a doctor\’s high prescription rate is coupled with poor record keeping or issuing prescriptions to patients who also are obtaining drugs from other physicians, the state agency will intervene, she said.
When the authority terminates a doctor from the Medicaid program, it also notifies the doctor\’s licensing agency of the action, she said.
Officials identified the three doctors terminated from the Medicaid program as R. Wayne Mosier, of Talihina, James M. Moody, of Oklahoma City, and Robert P. Chandler, of Broken Bow/Idabel. All were doctors of osteopathy.
Records for 2008 show Mosier wrote 208 Medicaid prescriptions for OxyContin, the sixth highest number for that specific brand. Moody wrote 151 prescriptions for OxyContin, the eighth highest number, while Chandler wrote 893 prescriptions for the generic version of Xanax, the third highest number in the state.
A spokesman for the state Board of Osteopathic Examiners said Mosier\’s license was suspended on June 18, 2009, and the license expired 12 days later. Moody was placed on probation for two years on June 18, 2009, for overprescribing, and his license expired Jan. 1, 2010. Chandler was placed on probation March 15, 2007, and the license was terminated March 19, 2009.
Moody and Chandler are now deceased, the spokesman said. Repeated efforts by The Oklahoman to reach Mosier for comment Friday were unsuccessful.
In Sen. Grassley\’s letter to Sebelius, he cited Oklahoma psychiatrist Richard Zielinski\’s writing of 1,606 Medicaid prescriptions for Abilify in 2008 and 2,093 prescriptions for the same drug in 2009 as examples of a doctor writing a lot more prescriptions for a drug than colleagues. The second most Abilify Medicaid prescriptions written in 2009 were 994 by Muskogee physician Charles Alan Lester.
Zielinski could not be reached for comment Friday. Greg Butler, a licensed professional counselor who works with Dr. Zielinski in Lawton, said Zielinski travels among several clinics and practices telemedicine, so it shouldn\’t be surprising that he has written the most Medicaid Abilify prescriptions.
Records at the Oklahoma State Board of Medical Licensure and Supervision show Dr. Zielinski was twice put on probation for substance abuse, most recently in 1999 for using drugs while on duty at Woodward Hospital and Health Center. His probation ended a year ago.
Nesser said the Oklahoma Health Care Authority looked at the individuals who had written the most prescriptions for Abilify and other anti-psychotic drugs but didn\’t find anything that looked inappropriate.
Records show Oklahoma City doctor Harvey Clarke Jenkins Jr. wrote more Medicaid prescriptions for OxyContin and its generic equivalents than anyone else in the state in both 2008 and 2009.
Records show he wrote 2,422 Medicaid prescriptions for OxyContin and its generic equivalents those two years — more than double the number written by anyone else.
Jenkins, an orthopedic pain management specialist, said his prescriptions need to be put in proper context.
Jenkins said many Oklahoma physicians refuse to treat Medicaid patients for pain because of poor reimbursement rates and because of the risk involved. They know regulators and licensing officials scrutinize doctors who prescribe narcotics because those drugs are commonly abused by patients. Instead of prescribing needed drugs for those patients, other doctors refer them to him, Jenkins said.
Jenkins said he goes to great lengths to try to avoid being conned.
“I\’m probably number one in this state and this region for the amount of urine testing that I do to make sure my patients are taking their medications. We test them every time they come in the door to make sure that they are in compliance and make sure the medicines are in their systems and make sure that they are not selling them,” he said.
Jenkins said he requires patients to sign and abide by agreements regarding their treatment and has an off-duty law enforcement officer present at his office to provide security. He also uses an Internet database that allows him to check on patients to see if they have been doctor shopping.
It\’s not always an easy job, he said, adding that he has been threatened by patients when he has refused to provide requested drugs.
“Every time I write a prescription for narcotics, if I don\’t follow the proper rules and regulations and be very diligent about it, my license is at risk,” he said. “A lot of physicians don\’t want to put their licenses at risk over things that are outside of their control.”
Records show the other top prescription writers for OxyContin and its generic equivalents for 2008 and 2009 combined were Dr. Glenn Charles Stow of Shawnee (1,159 prescriptions), Dr. Joseph Knight of Tulsa (1,107 prescriptions) and Dr. Steve Louis Schoelen of Newcastle (964 prescriptions).
None of them returned telephone calls Thursday or Friday seeking comment.
Schoelen was placed on five years probation by the state medical board in 2006 after he was arrested for driving under the influence of prescription drugs for which he had no prescription.