Carper, Coburn Highlight New Administration Proposal to Combat Fraudulent Drug Diversion From Medicare

WASHINGTON- Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) and Ranking Member Tom Coburn (R-Okla.) commended the Centers for Medicare and Medicaid Services (CMS) for moving forward on key proposals to curb the fraudulent diversion of prescription drugs from the Medicare program. The announcement follows a hearing the Committee held in June that highlighted the need for stronger oversight of the Medicare prescription drugs program.  

“I welcome the steps that the Centers for Medicare and Medicaid Services (CMS) is taking to curb the fraudulent diversion of drugs from Medicare,” said Chairman Carper. “For years, Medicare has lost millions of dollars due to fraudulent prescriptions for painkillers and other drugs. This fraudulent activity is not only a financial drain on a vital federal program, but it is also harmful to those struggling with prescription drug abuse. These commonsense reforms will help provide CMS with the tools and authority needed to actively combat this type of waste and fraud while protecting Medicare beneficiaries and strengthening the Medicare program.”

“I applaud Medicare officials for adopting policies that will enable program integrity experts to review and act on abusive and harmful prescribing of powerful drugs and controlled substances,” said Dr. Coburn. “The vast majority of physicians are professionals who want to help patients. Yet, where there is proof of abuse or fraud, CMS should take necessary actions to protect patients and taxpayers. Moving forward, it will be important for Medicare officials to implement this policy in a manner that is data-driven, thoughtful, and helps educate the provider community.”

The new proposal allows CMS to more quickly identify suspect Medicare prescriptions and actively prevent providers from charging the Medicare program for unnecessary medications. For example, CMS will be able to remove providers whose licenses to prescribe prescription painkillers or other controlled substance have been revoked by state regulators.  In addition to providing enhanced enforcement capabilities, these reforms will fix a loophole in the Medicare Part D program that allows providers to prescribe medications, even if they are not approved Medicare providers.

During the June 2013 hearing, testimony by CMS, the Health and Human Services Office of Inspector General and others showed that CMS’s oversight of the Part D program lacked effective controls to prevent waste and fraud. Witnesses testified that CMS should use its existing authority to enhance its oversight procedures to protect the Medicare Prescription Drug Program and save taxpayer dollars, and work with Congress on other steps that may require new legislative authority. Many of the reforms suggested by the witnesses are reflected in CMS’s new proposal.

The proposal by CMS is open for comments, and is scheduled for final adoption in January of 2015.