Painful Pills

January 5, 2012

HealthcareAmericans now use 70 percent of the world’s legal supply of narcotics.  As a result, the number of deaths from narcotic overdoses has tripled in the last decade.

Now, drug companies are developing pain pills that have 10 times the amount of the highly addictive painkiller hydrocodone as the current painkillers such as Vicodin.

Although this might be good news for those who truly suffer with chronic pain, it is bad news for taxpayers who are left paying the bill for prescription pill abuse through Medicare and Medicaid.

This fall, the Government Accountability Office issued a report finding that 170,000 Medicare Part D beneficiaries were doctor shopping and receiving prescriptions for painkillers and other narcotics far in excess of what any individual could safely use.

The report found that these Medicare beneficiaries were receiving prescriptions from five or more doctors for often-abused medications, including oxycodone and hydrocodone.

One Medicare beneficiary was able to get prescriptions for 3,655 oxycodone pills from 58 prescribers.

In 2008 alone, the cost to Medicare for pain medications was nearly $148 million.

And that’s just Medicare.

When the New York Department of Health reviewed prescription data for the first half of 2010, it found that 46 percent of oxycodone prescriptions paid for by Medicaid went to possible doctor shoppers.

New York spent $66.7 million in Medicaid funds just on oxycodone in 2010.  This means more than $30 million went to buy drugs for likely oxycodone abusers.

Although individuals who doctor shop are a problem, the demand for narcotic painkillers also creates an increased opportunity for Medicare and Medicaid fraud.

In October, fourteen people were indicted for their alleged involvement in a drug distribution ring in Los Angeles. During its 18-month operation, the ring wrote OxyContin prescriptions for Medicare, Medi-Cal and uninsured patients, billed the public insurance programs for the prescriptions, and then sold them for $23 – $27 per pill.

The ring distributed more than a million pills and billed the government $2.7 million.

In August, a Michigan pharmacist was indicted for running a scheme that allegedly billed the government more than $57 million for fraudulent prescriptions for OxyContin, Vicodin, and other narcotics.

In June, a Louisiana pharmacist and 51 Medicaid recipients he had recruited were arrested and charged with Medicaid fraud for their participation in a scheme relating to fraudulent prescriptions for OxyContin and hydrocodone.

A New Jersey doctor was indicted this summer because he continued to write prescriptions for pain pills and seek Medicaid reimbursement even though his license was suspended in 2009.

In Florida, the DEA and HHS are teaming together to focus on the “South Florida phenomenon” of health clinic owners who conspire with doctors and pharmacists in schemes to distribute oxycodone while also defrauding Medicare.

And these are just a few examples from the last half of 2011.

So far, federal regulators have been unable or unwilling to effectively limit the abuse of narcotic pain medications.  Before pain pills 10 times stronger become available, this country needs better controls to stop the fraud, abuse, and deaths these pain pills are causing.