Former government officials, analysts and researchers say Medicare could improve oversight of its Part D drug benefit with these steps:
1. Regularly analyze data to identify high prescribers of drugs that are frequently abused, misused or particularly risky for the elderly. Search for those who prescribe drugs for patients outside the intended population, such as children receiving Alzheimer’s medications.
2. Compare prescriptions with patient diagnoses kept by Medicare’s separate hospital and physician programs. Check whether drugs are appropriate for patients’ conditions and whether doctors are prescribing without actually seeing the patients.
3. Require private insurers in Part D to report suspected fraud, waste and abuse to the contractor Medicare hires to look for fraud, a step recommended by the Office of the Inspector General of the Department of Health and Human Services. Such sharing is now voluntary.
4. Seek congressional authority to suspend prescribers from Part D if they have been indicted or arrested on prescription drug charges or if they present an imminent risk to patients.
5. Require health providers to enroll in Medicare to have prescriptions covered by Part D. Enrollment requires providers to disclose past license sanctions and criminal convictions. Under the Affordable Care Act, Medicare can require enrollment in order to prescribe, but it hasn’t done so.
6. Routinely get prescribing records from state Medicaid programs, as well as the names of providers whom those programs have terminated — especially for improper drug choices.
7. Require diagnosis codes on prescriptions, at least for commonly abused or misused drugs, as some Medicaid programs now do and as recommended by the inspector general.
8. Share prescribing information with state medical boards, which license and discipline doctors.