Grassley Sends Letters Examining Overprescription of Drugs in Medicaid Programs

Grassley Sends Letters Examining Overprescription of Drugs in Medicaid Programs

By Rebecca Adams, CQ HealthBeat Associate Editor

The top Republican on the Senate Judiciary Committee is demanding that 46 Medicaid directors answer questions about how they are overseeing physicians who may be overprescribing potentially addictive painkiller or mental health drugs.


Sen. Charles E. Grassley, R-Iowa, is one of several senators who has raised concerns about whether some physicians are committing Medicaid fraud or allowing patients to abuse the use of the drugs. Medicaid is the federal-state program for the low-income.


“When a doctor writes more prescriptions than seems humanly possible, it makes sense to ask questions,” Grassley said in a written statement. “Maybe there’s a logical explanation or maybe there’s poor medical care or even fraud...If state and federal taxpayers are being cheated because of inappropriate prescriptions, the state and federal governments have to get to the bottom of it and stop it. 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.”


The Republican is sending letters to 34 Medicaid directors who provided some information after Grassley wrote state officials in 2010 asking them to identify the top prescribers of several pain management and mental health drugs. He is sending another letter to 12 states that didn’t respond to his initial request. Grassley was satisfied with the responses from a handful of other states. The letters were first reported Tuesday by ProPublica.


In the letters, Grassley wrote, “Mental health drugs continue to be prescribed at astounding rates and pain management clinics are turning into a hotbed for black market painkillers. When these drugs are prescribed to Medicaid patients, it is the American people who pay the price for over-prescription, abuse, and fraud. After an extensive review of prescribing habits of the serial prescribers of pain and mental health drugs, I have concerns about the oversight and enforcement of Medicaid abuse in your state.”


Each letter was tailored to cite specific concerns in a state, but Grassley is asking all of the 34 states to answer a dozen questions by Feb. 13. The questions include probes about whether a state’s top prescribers continue to be allowed to bill Medicaid; if the state has a system to monitor excessive prescription writing; what types of sales restrictions and databases to track drug sales exist; and what kinds of interactions the state has had with federal Centers for Medicare and Medicaid Services (CMS) officials about the issue.


Grassley noted that Florida officials “finally terminated a doctor from Medicaid for high numbers of prescriptions but that was slow-going.”


Florida Gov. Rick Scott also signed a law in June to crack down on the state’s “pill mills” that hand out prescription pain drugs. Nearly 15,000 people die every year of overdoses of prescription painkillers, which is more than the number of people who died as a result of overdoses of heroin and cocaine combined, according to the Centers for Disease Control and Prevention.The problem of potential abuse of painkiller or mental health drugs is also a problem in Medicare, the federal program for seniors and people with disabilities. Not only are some physicians writing too many prescriptions, but some patients are apparently visiting multiple doctors to get additional prescriptions. CMS officials have been collecting public comments on ways to strengthen its oversight of prescription painkillers. A Government Accountability Office (GAO) report found that at least 170,029 individuals in Medicare got prescriptions for often-abused painkillers from five or more physicians, which indicated that the patients might be visiting different doctors to get more painkillers than a physician would normally give to one patient.


But Grassley said that efforts to crack down on overprescribing in Medicaid have been lackluster.
“I haven’t noticed a groundswell of state or federal efforts to get to the bottom of anything that looks questionable since I made my original inquiry in 2010,” he said in his statement.