By Andrew Conte
One Pennsylvania doctor wrote prescriptions for more than $1 million worth of an antipsychotic drug. Another averaged 25 scrips a day for the antidepressant Xanax.
In both cases, federal taxpayers footed the bill through the Medicaid program for the poor. Some doctors are so prolific with dispensing government-funded drugs that a U.S. Senate investigation recently determined investigators should look for evidence of fraud or drug abuse.
\”Government needs to do more,\” Sen. Charles Grassley, R-Iowa, ranking member on the Senate Finance Committee, wrote in an e-mail to the Tribune-Review. \”(Federal) programs can\’t spare a dime for improperly prescribed drugs, so outlier prescribers should be monitored more closely.\”
The committee asked agencies in every state to provide information on the 10 doctors who wrote the most prescriptions for eight common Medicaid-funded antipsychotics and painkillers in each of the past two years. The investigation also looked at Medicare prescriptions, which private agencies monitor for the federal government.
Pennsylvania\’s Department of Public Welfare provided information on how often doctors prescribed drugs, but the agency declined to identify the doctors. A spokesman said the physicians could have legitimate reasons for relying repeatedly on certain drugs.
\”The volume of prescriptions and costs isn\’t always an indicator of improper, abusive or fraudulent prescribing,\” Public Welfare spokesman Michael Race said.
Doctors who prescribe a relatively larger amount of a specific drug often can explain the difference, but not always, said Chuck Moran, spokesman for the Pennsylvania Medical Society. In a rural area where few psychiatrists accept Medicaid patients, one doctor might see many people, he said. Patients might demand drugs that have heavy direct-to-consumer advertising, he added.
\”Sometimes outliers exist, and they draw attention,\” Moran said. \”Whether or not it\’s justified is the question.\”
The Pennsylvania data followed national trends the Senate committee reported in a recent letter to the U.S. Department of Health and Human Services. It found that in many states the top prescriber for a particular drug often wrote several times more prescriptions than the 10th-highest one.
The Senate investigation identified several \”extreme\” cases: One Florida doctor wrote 96,685 prescriptions for mental health drugs in a 21-month period; another in Texas wrote more than 14,000 prescriptions for Xanax last year.
In Pennsylvania, one doctor wrote 6,476 prescriptions for Xanax, or four times more than the 10th-highest doctor.
For Seroquel, a drug used to treat depression and schizophrenia that can cost up to $12 per tablet, one doctor handed out more than 2,200 prescriptions with a total cost of more than $1 million. The physician who ranked lowest among the 10 wrote 1,400 prescriptions, costing $150,000.
When Public Welfare officials suspect fraud, they refer cases to the Attorney General\’s Office for investigation and prosecution, Michael Nardone, the acting secretary, wrote in a letter to the Senate committee.
Last year, Public Welfare opened 2,403 fraud investigations of providers and referred 23 cases for criminal investigation, Race said.
On any given day, state prosecutors are working on some form of Medicaid or insurance fraud, often involving prescription drugs, spokesman Nils Frederiksen said. In one Lawrence County case that the attorney general prosecuted, he said, several physicians set up a practice and illegally wrote dozens of prescriptions every day.
\”That\’s an argument we make in criminal cases involving medical professionals: When you\’re prescribing outside of the standard practices, prescribing to known addicts and prescribing huge volumes, how could you not know what\’s going on?\”
In March, the office arrested a York County doctor and charged him with illegally prescribing large amounts of painkillers, including some that had been charged to Medicaid. Over seven months last year, the physician wrote one man prescriptions for 9,500 tablets of OxyContin, an average of nearly 50 tablets a day, or enough to kill him, according to the Attorney General\’s office. It said the doctor billed Medicaid more than $73,000 for illegally prescribed painkillers.