Medicare fraud report finds $350 million in prescription bills from just 736 doctors

by Heygood Orr and Pearson

A new government report has revealed that just 736 doctors were responsible for more than $350 million in Medicare prescription drug billings in one year. The report, prepared by the Inspector General of the U.S. Department of Health and Human Services, states that the high number of prescription painkillers prescribed by 736 doctors, combined with the large number of pharmacies that were used to dispense the prescriptions, suggests that the doctors were engaged in fraud.

The Inspector General’s report examined the prescribing practices of about 87,000 general care physicians who took part in the Medicare prescription drug program, which accounts for about 25% of all medications prescribed in the U.S. each year. The report examined several factors—including prescriptions per patient, the number of painkillers and other addictive drugs that were prescribed, and the number of pharmacies that dispensed the prescriptions—in order to identify potential cases of fraud.

The report identified 736 doctors as “extreme outliers” because of their questionable prescribing practices. These cases included at least 24 doctors who were found to have written more than 400 prescriptions to just one patient and an Illinois physician who had prescriptions filled by 872 pharmacies in 47 states and Guam. On average, the doctors wrote 13 prescriptions per patient and had prescriptions filled by Medicare patients at 52 pharmacies.

The overprescription of narcotic painkillers such as fentanyl, hydrocodone, oxycodone, and methadone can place patients at risk of an overdose and increase the likelihood that they may become addicted to their medications. Hundreds of wrongful death lawsuits have been filed against physicians whose inappropriate prescription of opioid painkillers caused patient deaths.