Burlington Free Press
Vermont doctor faces prescription investigation
By Sam Hemingway
May 6, 2012

A doctor identified by the Department of Vermont Health Access as one of the top Medicaid prescribers of narcotic and other federally regulated medications in the state is under investigation by the Medical Practice Board for excessive prescribing of some of the drugs.

“We looked at specific prescribing practices and identified something that was far enough outside the norm that we felt it warranted further investigation,” Mark Larson, the department commissioner, said last week.

The decision to refer the doctor to the board for investigation was first disclosed in a Feb. 13 letter Larson sent to Sen. Charles Grassley, R-Iowa, and obtained by the Burlington Free Press.

Grassley, during the past three years, has been pressing medical officials in the 50 states for information about suspected over-prescribing practices connected with the government’s Medicaid program.

“When a doctor writes more prescriptions than seems humanly possible, it makes sense to ask questions,” Grassley said in a statement last week. “Maybe there’s a logical explanation or maybe there’s poor medical care or even fraud. … Medicaid serves millions of people and costs billions of dollars. The more money wasted, the less there is for the people who rely on the program.”

Larson, in an interview, declined to identify the physician who is the focus of the Medical Practice Board’s investigation, citing federal health-care-confidentiality rules. He said, however, that the review by the board is ongoing.

“The case is not resolved. There is not a conclusion to it,” Larson said.

David Herlihy, director of the Medical Practice Board, was tight-lipped on the matter Friday, declining even to confirm that his board had received a referral from another agency of state government about an unnamed physician’s prescribing practices.

“I can’t comment on any case that is under investigation,” Herlihy said. “If a times comes when there are charges, then it becomes public.”

The drugs that Grassley’s inquiry has focused on include Amblify, Geodon, Seroquel, Zyprexa, Risperdal, OxyContin, Roxicodone and Xanax, according to the correspondence between Grassley’s office and the state. Vermont health officials have called the abuse of prescription narcotic drugs in the state an epidemic.

Figures provided to Grassley by the state show that the amount of money billed to Medicaid by the top 10 prescribers for each of the medications usually was under $50,000 per year, but in several instances the amounts exceeded $100,000 for a particular medication.

In 2011, for example, one physician billed Medicaid for $101,572 worth of prescriptions for Amblify; another doctor prescribed $123,980 of Seroquel; and yet another doctor billed Medicaid for $104,688 of Zyprexa. All three are powerful anti-depressant drugs meant to treat schizophrenia and bipolar disorders.

The prescribing of Seroquel by Vermont doctors to treat conditions the drug was not meant to address was of particular concern, Larson’s letter to Grassley stated.

“Based on a review of medical and medication claims, we identified some physicians who were using Seroquel for inappropriate indications such as sleep and anxiety disorders,” Larson’s letter stated.

The department subsequently put in place a protocol that required doctors to get authorization for prescribing Seroquel in “low-dose” situations like sleep and anxiety disorders, a move Larson stated in the letter “has been effective in mitigating inappropriate use of low dose Seroquel.”

Larson said Grassley’s inquiry into Vermont prescribing practices was not the sole reason the Department of Vermont Health Access referred one of the top 10 prescribers to the Medical Practice Board for investigation.

“We in fact have systems already in place to look into the kind of questions he asked,” Larson said. “I am comfortable that we have systems capable of catching these cases and sending them to the Medical Practice Board.”