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

By ProPublica  
   February 10, 2017

Finally, in October 2016, CMS pushed it off until January 2019. Beginning this spring, it said it will block prescriptions from doctors who have been barred from participating in federal health programs, those ousted from the Medicare program for other reasons, and those convicted of a felony in the past 10 years.

The delays have enabled troubled doctors to continue prescribing—while still having their prescriptions paid for by Medicare.

A family practice doctor in Michigan, for example, was charged in December 2012 with conspiracy to commit fraud and illegally distributing a controlled substance. But he wrote 7,864 prescriptions in Part D in 2014. In fact, 41 percent of his Part D patients received at least one prescription for a narcotic painkiller that year. He pleaded guilty in 2015 and was sentenced to seven years in prison.

And in Georgia, a nursing home doctor kicked out of Medicare in February 2014 for "abuse of billing privileges" nonetheless wrote nearly 45,000 prescriptions covered by the program that year.

While CMS has delayed its enrollment requirement, it has begun to review the reams of data it collects to identify doctors with aberrant prescribing patterns. It sent a round of letters to doctors, alerting them to how they compared to peers, but a study in the journal Health Affairs last year found that the letters were ineffective at changing behaviors.

A second round of letters, which contained stronger warnings, has led to a small change in prescribing practices, Morse said.

"Rather than saying, 'Hey we've noticed that you have this odd or higher than average prescribing behavior,' now it's much more 'We plan to take action if your behavior does not fall into line with that of your peers,'" he said. "It has become more effective because the letter is more strongly worded."

Compare your doctor's medication prescribing to his or her peers using the Prescriber Checkup tool. Read other stories in the series, The Prescribers.

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


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