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Medicare Part D: Instances of Questionable Access to Prescription Drugs

GAO-12-104T Published: Oct 04, 2011. Publicly Released: Oct 04, 2011.
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This testimony discusses the results of our investigation of fraud and prescription drug abuse in Medicare Part D. Prescription drug abuse is a serious and growing public health problem. According to the Centers for Disease Control and Prevention, drug overdoses, including those from prescription drugs, are the second leading cause of deaths from unintentional injuries in the United States, exceeded only by motor vehicle fatalities. Unlike addiction to heroin and other drugs that have no accepted medical use, addiction to some controlled substances can be unknowingly financed by insurance companies and public programs, such as Medicare Part D. This statement today summarizes our report, describing indications of doctor shopping in the Medicare Part D program for 14 categories of frequently abused prescription drugs. The objectives of the forensic audit and related investigation were to (1) determine the extent to which Medicare beneficiaries obtained frequently abused drugs from multiple prescribers, (2) identify examples of doctor shopping activity, and (3) determine the actions taken by the Centers for Medicaid & Medicare Services (CMS) to limit access to drugs for known abusers.

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Access to health careBeneficiariesClaimsComparative analysisControlled substancesSubstance abuseDrugsFraudHealth care programsMedicaidMedicareNarcoticsPatient care servicesPharmaceutical industryPhysiciansPrescription drugsPrivate sectorProgram abusesProgram evaluationSubstance abuse