The Tennessean
By Brandon Gee

A powerful U.S. senator is turning a spotlight on doctors who overprescribe commonly abused medications, but he has found a challenge in getting the names of the doctors from some states, including Tennessee.

Still, the data that Tennessee sent from its TennCare program shows that some doctors prescribe far more than others of the costly medications – and taxpayers foot the bill.

U.S. Sen. Charles Grassley,R-Iowa, believes overprescribing is contributing to the growth in taxpayer dollars spent on health-care programs such as Medicaid, which cost states and the federal government $317 billion annually.

Grassley asked states to provide a list of the top 10 prescribers of eight antipsychotic and pain medications. Tennessee is one of a handful of states that chose not to provide information that could identify the individual doctors in its response to Grassley.

According to the lists submitted by TennCare Director Darin Gordon to Grassley and the Senate Finance Committee in May, one Tennessee doctor wrote 2,060 prescriptions for three of the antipsychotic medications last year. TennCare covered more than $990,000 of the cost of that doctor\’s prescriptions, which went to 763 distinct patients. Fourteen Tennessee doctors wrote more than 1,000 prescriptions last year for the drugs Grassley asked about, an analysis of the lists showed.

As it responded to Grassley\’s request, TennCare also took its own look at the top prescribers, spokeswoman Kelly Gunderson said. She said the bureau looked at the physicians\’ specialties to see whether the prescriptions matched their scope of practice. An unspecified number that warranted further investigation were forwarded to TennCare\’s Provider Fraud Task Force.

The task force hasn\’t identified any instances of fraud or inappropriate prescribing that it would turn over to the Tennessee Bureau of Investigation, Gunderson said. Two doctors on the lists, however, have since had their medical licenses suspended and been sanctioned so that they can no longer participate in Medicare or Medicaid programs, including TennCare, which administers the Medicaid program in Tennessee. TennCare would not reveal the two doctors\’ names, so The Tennessean could not investigate the specific reasons that the state health department suspended their licenses.

Overall, Tennessee\’s top prescribers did not exhibit the types of high numbers that have particularly troubled Grassley.

In other states, doctors have been found to write tens of thousands of prescriptions for the drugs. One Florida doctor wrote 96,685 prescriptions for mental-health drugs in a 21-month period.

More scrutiny urged
In an October letter to Health and Human Services Secretary Kathleen Sebelius, Grassley said that, while the information on top prescribers doesn\’t prove illegal activity, it does warrant further scrutiny.

\”This may be because a particular physician has a specific expertise or patient population,\” Grassley wrote, \”but it might also suggest overutilization or even health-care fraud.\”

Grassley asked for information on the drugs Abilify, Geodon, Seroquel, Zyprexa, Risperdal, OxyContin, Roxicodone and Xanax. In the letter to Sebelius, he noted the big gaps between the top prescribers of certain medications and the 10th-highest prescribers of the same drugs. In Tennessee, for example, the doctor who prescribed the most Risperdal, a mental-health medication, wrote 1,481 prescriptions for the drug. The 10th doctor on the list wrote 851.

\”The trend is found again and again across the states,\” Grassley wrote, \”suggesting that top prescribers stand out not only against other providers in their state, but against the very top prescribers in those states.\”

Tennessee, along with eight other states, chose not to provide its top prescribers\’ names or prescriber numbers.

In his letter to Grassley, Gordon wrote that he worried \”identifying these providers could lead to severe consequences stemming from faulty conclusions.\”

\”We don\’t want to see a provider unjustly accused of improper care,\” Gunderson said. \”The second you start putting that out, people begin drawing their own conclusions.\”

Not all states respond
According to Jill Gerber, a spokeswoman for Grassley, five states provided doctors\’ names, 24 turned over prescriber identifiers that can be used to identify doctors and nine, such as Tennessee, assigned doctors a random number that cannot be used to identify them. Alabama declined to provide any information at all, and 11 states haven\’t responded yet.

Allen Jones, a former investigator in the Pennsylvania Office of the Inspector General turned prominent pharmaceutical industry whistleblower, said he\’s troubled that states would withhold names.

\”It absolutely should be public. These are taxpayer dollars being spent on behalf of our most vulnerable citizens,\” Jones said.

\”I can\’t see any rationale for secrecy regarding the information Grassley asked for.\”

While he doesn\’t have any specific knowledge of wrongdoing in Tennessee, Jones said he suspects many top prescribers have inappropriate relationships with pharmaceutical companies, such as pushing the drugs of companies that pay them for services such as speaking engagements. He said that the more secret things are kept, \”the more open and ripe the situation is for fraud and abuse.\”

According to a ProPublica investigation into the influence pharmaceutical companies have on patient care, 43 doctors received more than $200,000 since 2009 from the seven companies that disclose payments for promotional work. Five of the doctors were from Tennessee, more than any other state. Tennessee is the 17th-largest state by population.

Gerber said Grassley\’s investigation is pending while he waits for a response to his October letter to Sebelius asking what steps the Department of Health and Human Services is taking to prevent the overuse of prescription drugs. He requested a response by Dec. 3. Gerber said Grassley has not yet come out with a position on whether top prescribers should be identified by name.

\”He\’s pushed for transparency in many other areas of the health-care system,\” Gerber said, \”so as this inquiry moves forward and HHS joins the conversation, data availability is certainly one of the topics on the table.\”