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OIG Report on Individuals Without “Prescribing Authority” Recommends Increased Monitoring of Medicare Part D Prescribers

A recent June 2013 Office of Inspector General (OIG) report titled, “Medicare Inappropriately Paid for Drugs Ordered by Individuals Without Prescribing Authority,” revealed that Medicare mistakenly paid a sum of $5.4 million for 75,552 Part D drug prescriptions ordered by 14 prescriber types without the authority to prescribe in any State. The 14 selected prescriber types the OIG based its study on include practitioners such as massage therapists, athletic trainers, nutritionists, dental hygienists, and nutritionists. Medicare does not pay for prescriptions ordered by practitioners who are not licensed to prescribe drugs.

The OIG piloted this study as part of the OIG’s Spotlight on Drug Diversion and also complements last week’s hearing on “Curbing Prescription Drug Abuse in Medicare,” which was held by the Senate Committee on Homeland Security and Governmental Affairs on June 24, 2013.

According to the report, the Centers for Medicare and Medicaid Services (CMS) agreed to the OIG’s urge to heighten monitoring over Part D prescribers. Specifically, CMS has concurred with the OIG’s recommendations to:

1. Mandate that sponsors confirm that their prescribers are authorized to prescribe drugs
2. Increase the Medicare Drug Integrity Contractor’s (MEDIC) watch over prescriber practices 3. Certify that Medicare is not paying for prescriptions ordered by individuals who do not have “prescribing authority”
4. Pursue the individuals who ordered prescriptions without authority
As this most recent report indicates, the OIG is heightening its scrutiny of Part D payments. As we alerted you to in a recent blog post about another OIG report on “questionable” Part D prescribing practices, the OIG is also concerned about the alleged overprescribing of narcotics, not only because of potential fraud for medically unnecessary prescriptions, but also because overprescribing contributes to narcotic abuse. All providers should anticipate increased scrutiny on prescribing practices, especially where prescriptions will be paid by Medicare Part D. CMS will be looking for proper credentials, such as M.D. certification and a DEA number. If you need assistance defending a Medicare audit or have any questions regarding the OIG’s findings, please contact an experienced healthcare attorney at 248-544-0888.

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