Sen. Carper Urges Center for Medicare and Medicaid Services to Address Waste and Fraud in Medicare Part D Prescription Drug Program

WASHINGTON – Today, in letters sent to Centers for Medicare and Medicaid Services (CMS) officials, Senator Tom Carper (D-Del.) urged CMS to determine a timeline for action on the issues of fraud and abuse with prescriber identifiers used under the Medicare prescription drug program. The letter asks CMS to report by August 16^th on the timeline for their plan.

As part of Medicare Part D, prescription submissions from physicians and other authorized prescribers must include an identifier. However, a recent audit by Health and Human Services Office of Inspector General (OIG), Invalid Prescriber Identifiers on Medicare Part D Drug Claims (OEI-03-09-00140), found that CMS has not established a process to ensure valid identification numbers on reimbursed prescriptions under the Medicare Part D prescription drug program.  The OIG’s audit showed that in 2007, $1.2 billion in Medicare Part D prescription drug claims contained invalid prescriber identifiers, representing more than 18 million prescription drug claims. The OIG described prescriber identifiers as valuable program safeguards for the Medicare prescription drug program. In fact, according to the OIG, these identifiers are the only data on Part D drug claims to properly identify legitimate prescribed medications for Medicare enrollees. 

"I was deeply troubled by a recent audit by the Health and Human Services Office of Inspector General (OIG) which found that the Centers for Medicare and Medicaid Services (CMS) does not ensure that the prescriptions being reimbursed under the Medicare Part D program have been prescribed by legitimate health professionals," said Sen. Carper, chairman of the Senate Subcommittee on Federal Financial Management and a member of the Senate Finance Committee.  "This report noted that in 2007, $1.2 billion in Medicare Part D prescription drug claims contained invalid prescriber identification, representing more than 18 million prescription drug claims.  This raises serious concerns about the potential misuse of taxpayer funds, let alone the public health concerns due to the diversion of medications that are controlled substances.  I look forward to hearing from the Administration about when they will take steps to tackle this serious problem so we can protect precious taxpayer dollars as well as curb the diversion of controlled substances from the Medicare Prescription Drug program."

Earlier this month, Sen. Carper’s subcommittee on Federal Financial Management held a hearing on improper payments in the Medicare program. In her testimony, CMS Chief Financial Officer, Deborah Taylor acknowledged the importance of the prescriber identifier problem.  Her testimony also described CMS’s next steps for improving the prescriber identifier process, including new policies and procedures to correct the prescriber situation, in addition to providing guidance and reminders to Medicare prescription plan sponsors.  

However, CMS provided no timeline for any of the proposed steps by CMS to address the problem of invalid prescriber identifiers.

A copy of Senator Carper’s letter follows:

July 29, 2010

The Honorable Peter Budetti

Deputy Administrator and Director

Center for Program Integrity

Centers for Medicare and Medicaid Services

U.S. Department of Health and Human Services

200 Independence Avenue, SW 
Washington, DC 20201

The Honorable Jonathan Blum

Deputy Administrator and Director

Center for Medicare

Centers for Medicare and Medicaid Services

U.S. Department of Health and Human Services

200 Independence Avenue, SW 
Washington, DC 20201

Dear Mr. Peter Budetti and Mr. Jonathan Blum:

The Senate Subcommittee on Federal Financial Management recently held a hearing that examined improper payments in the Medicare program.  One of the major focuses of the hearing was prescriber identifiers used under the Medicare prescription drug program.

A recent audit by the Health and Human Services Office of Inspector General (OIG) found that the Centers for Medicare and Medicaid Services (CMS) has not established a process to ensure valid identification numbers on reimbursed prescriptions under the Medicare Part D prescription drug program.  As you know, CMS requires that prescription submissions include an identifier, but Invalid Prescriber Identifiers on Medicare Part D Drug Claims (OEI-03-09-00140) detailed that $1.2 billion in Medicare Part D prescription drug claims contained invalid prescriber identifiers in 2007, representing more than 18 million prescription drug claims. 

The OIG described the prescriber identifiers as valuable program safeguards for the Medicare prescription drug program.  In fact, these identifiers are "the only data on Part D drug claims to indicate that legitimate practitioners have prescribed medications for Medicare enrollees."  The OIG concluded "it appears that CMS and Part D plans do not have adequate procedures in place to detect invalid values in the prescriber identifier field."  

The testimony the subcommittee received from the CMS Chief Financial Officer, Ms. Deborah Taylor, described the next steps for improving the prescriber identifier process.  I appreciate her candid statements describing the importance of prescriber identifiers in curbing waste and fraud, as well as the dedication by CMS to take necessary steps to rectify the situation outlined in the OIG’s report.   CMS has described new policies and procedures under consideration to correct the prescriber situation, including guidance and reminders to Medicare prescription plan sponsors.  

However, it is unclear whether and when CMS will implement these steps to correct the prescriber identification problem.  I, therefore, request that you provide by August 16^th a timeline for actions by CMS.

If you have any questions or if I can be of assistance to you, please feel free to contact me, or ask your staff to call Peter Tyler in my subcommittee office at (202) 224-8707.

With best personal regards, I am

                                                                        Sincerely yours,

                                                                        Thomas R. Carper

                                                                        Chairman

                                                                        Subcommittee on Federal Financial

                                                                        Management, Government Information,

                                                                        Federal Services, and International Security

CC:      Ms. Deborah Taylor, Director and CFO

Office of Financial Management

Centers for Medicare and Medicaid Services

U.S. Department of Health and Human Services