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GAZETTE (Cedar Rapids, Iowa)
By Paul Barton
Source: Capitol News Connection

WASHINGTON — Medicaid doctors nationwide prescribing sky-high totals of psychiatric drugs have set off fraud sensors belonging to Sen. Chuck Grassley, R-Iowa.

Grassley, a member of the Senate Finance Committee that monitors the federal-state health care program for the indigent, wants Kathleen Sebelius, secretary of Health and Human Services, to find out why some doctors are writing tens of thousands of prescriptions for mental health medicines and other \”widely abused\” drugs, including narcotics, over just one or two years.

The Iowa senator has gathered information from all 50 states.

While he can\’t be certain of fraud, \”it certainly raises the question,\” Grassley, one of Capitol Hill\’s fiercest watchdogs, said in an interview. Some doctors, he said, are clearly \”outliers\” in their Medicaid prescription patterns.

It matters, he said, because the too many prescriptions may be endangering patients, not to mention wasting taxpayer dollars. The federal government provides close to $300 billion a year in Medicaid funding.

One cause of possible waste and fraud, he said, may be pharmaceutical companies colluding with doctors. Grassley said HHS, along with federal attorneys general and U.S. attorneys, have plenty to examine.

Some of his more startling discoveries:

*A Florida physician who wrote 96,685 prescriptions in 21 months, an average of 135 a day if he were working 365 days a year. \”You wonder how he can be writing his name that many times,\” Grassley said. His work included about 14,000 prescriptions for Xanax alone.

*An Ohio doctor who wrote more 50,000 prescriptions in 2008 and 40,000 in 2009.

*A Texas health care provider who wrote about 27,000 prescriptions for Xanax over two years.

Iowa prescription rates did not seem as worrisome, Grassley\’s staff said, although one Iowa doctor wrote 1,101 prescriptions for Risperdal in 2008.

\”When certain providers are writing prescriptions at rates that far outpace their peers, it might be because they have a different patient population,\” Grassley said. \”But in some cases it might be fraud.\”

About the possibility of collusion, Grassley said drug companies often track prescriptions and find ways to indirectly compensate physicians. For instance, they may pay honoraria to speak about the effectiveness of a particular medicine. Pharmaceutical companies, he added, have also been known to buy meals for a doctor\’s staff and provide gifts.

Grassley\’s inquiry comes as some patient advocacy groups also sound alarms about doctors unnecessarily prescribing psychiatric medicines, especially for children.

The Alaska-based Law Project for Psychiatric Rights has no doubt about drug companies enticing doctors to overprescribe. Some of the methods it alleged in an e-mail:

*Developing articles trumpeting the effectiveness of drugs and having prominent psychiatrists put their names on them — \”ghost writing.\”

*Burying studies that show adverse affects for a particular drug.

*Publishing the same data many times to enhance a drug\’s reputation.

*Paying key \”opinion leaders\” to hail the advantages of their products.

*\”Outright lying\” about results.

When asked about schemes to generate unwarranted prescriptions, the Washington office of the Pharmaceutical Research and Manufacturers of America did not respond directly.

Instead it issued a lengthy statement saying helping patients attain \”the best available treatment\” is a goal the industry shares with \”everyone in our health care system.\”

The statement also said: \”In the end, the best solution for all patients is to strike the right medical balance between the proper and effective use of prescription medicines and other therapies and interventions.\”

In a related matter, Grassley has passed legislation that calls for more disclosure about drug companies\’ relationships with doctors. It takes effect in 2013, but some companies are complying ahead of time.