This is a sad story of a tiny snowball that starts rolling down a mountain, growing larger by the minute. It’s a story of the abuse of human beings who are given too many pain killers, powerful antipsychotic and anti-anxiety drugs. Tragically, many of the patients are children, some under three years of age. Many of these little ones have been through physical or mental stress in their short lives. Prescribing drugs to toddlers is considered “off-label” – uses not approved by the federal Food and Drug Administration. By the time the snowball reaches the bottom of the mountain, taxpayers, Medicare and Medicaid are the victims of fraudulent prescription costs.
According to a recent report by the Fort Worth Star-Telegram, $47 million worth of Medicaid prescriptions have been written over the past two years in Texas, by a handful of physicians. The top five doctors alone wrote $18 million worth. In their report, based on sources such as the Texas Department of Health and Human Services, Texas Medical Board, U.S. Senate Finance Committee, and Medicaid vendor drug claim files, the following information represents these two sets of data. These sets listed the top 10 Medicaid prescribers of antipsychotic drugs, such as Zyprexa, Abilify and Seroquel. We won’t name names, but the #1 physician wrote 44,138 prescriptions that were filled at a cost of $6,370,005. The next four doctors had written prescriptions costing from $4,643,626 to $1,996,043. The top prescribers of drugs known as psychotropics, (referring to different types of mental-health drugs, possibly including antipsychotics,) given from 2005 or 2006 to 2009 totaled more than 120,747 by five physicians. Many physicians have physician assistants that can write prescriptions under their name, and some clinics are probably included in these figures.
If this is going on in Texas, how about all the other states, and who is paying the bill? One news article stated that in Ohio, a physician wrote 102,000 prescriptions in two years. Another doctor in Miami wrote almost 97,000 in 18 months for mental health patients. Thirty-four states have a State Prescription Drug Monitoring Program. There are statewide databases that collect designated data on dispensed substances and this information is housed by a specific statewide regulatory, administrative or law enforcement agency. Data is distributed to individuals who have the authority under state law to receive the information for the purpose of determining if it is legitimate medical use of controlled drugs or identify and deter previous drug abuse. The Drug Enforcement Agency is not involved in these state programs.
Kaiser Health News and the Star-Telegram both have reported that Republican Senator Charles Grassley of Iowa is pressuring Health and Human Services officials to investigate why some physicians write massive amounts of scripts for tax-funded Medicare and Medicaid programs. Prescription drug fraud in the U.S. costs an estimated $60 billion to $90 billion a year to these programs. As it stands now, physicians in question may be sent before a medical review board or for education, which amounts to a slap on the wrist. Our state has automated ways to check these records and catch overuse, incorrect dosage and misuse. Each state should have some type of similar system. But how do we stop them? And what about the safety of patients who are given these huge doses of medications?
For those who truly need help with mental or physical needs, we are grateful for medications. Many times persons can be helped with therapy as well, and/or medicine. Years ago, these powerful drugs did not exist, and we wonder how people overcame or coped with their problems. Hopefully, they had the help and support of caring families and friends.
Most of our doctors really care about us and want us to stay healthy. Many are cautious about even over-prescribing antibiotics, because these meds eventually won’t help if given too often. We appreciate physicians for their diligence, seeing us in the middle of the night in an emergency room, and upholding the oath they took when they became doctors.
Hopefully, the Federal Health and Human Services officials will take action to remedy this fraudulent behavior. They owe it to the taxpayers to do what is right and figure out a way to penalize those physicians who are abusing the system (and their patients). A part of operating local hospitals or clinics require physicians or an oversight committee to review patient’s records and determine if the care of each patient was appropriate. This should be done on a regular basis. It takes time, but is worth it to save someone’s life. There must be a way to stop prescription fraud.
Look at a map of the United States, and picture it covered with all those snowballs!