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How a Simple Fix to Reduce Aberrant Prescribing Became Not So Simple

By ProPublica  
   February 10, 2017

As a result, the government is still covering prescriptions written by doctors who have been kicked out of Medicare and even some who have pleaded guilty to crimes. Three New Jersey doctors who pleaded guilty in July 2013 to charges related to a bribery scheme continued prescribing drugs to Medicare patients the following year, a ProPublica review found.

One of those doctors, Franklin Dana Fortunato, told ProPublica that he was advised that he could continue treating patients between his guilty plea and his sentencing in May 2015.

In addition, at least 40 doctors kicked out of Medicare before 2014 had their prescriptions covered by Medicare's prescription drug program, known as Part D, that year, a ProPublica analysis shows.

Much of the reason for the delay rests with dentists. Medicare, which provides health care to seniors and the disabled, doesn't typically cover dental services, but the Part D program pays for drugs, such as antibiotics or painkillers, that dentists order for beneficiaries.

"Since Medicare covers very few dental item and services, many (perhaps most) dentists have little incentive to enroll in Medicare" outside of this requirement, the American Dental Association wrote to CMS in September 2016. The dental group also said the enrollment process is too complex and that CMS already has the information it needs to address fraud and abuse concerns.

ProPublica analyzed all providers who wrote at least 50 prescriptions for at least one drug in Part D in 2014. All told, more than 92 percent of the 428,000 providers were enrolled in Medicare. But among 18,500 dentists, almost the exact opposite was true: More than 82 percent weren't enrolled.

ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest.


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