HHS' inspector general's office found that nursing home residents were receiving too many atypical antipsychotic drugs, largely in prescriptions that were off-label, according to a new report.
Inspector general's office finds misuse of antipsychotic drugs in nursing homes
For the six months ended June 30, 2007, the inspector general found that 51% of Medicare claims for atypical antipsychotic drugs were erroneous and were valued at $116 million, and that 83% were for off-label use. The report was requested by Sen. Chuck Grassley (R-Iowa) out of a concern that the drugs were being misused, according to the inspector general's report summary.
The inspector general recommended that the CMS: facilitate access to information necessary to ensure accurate coverage and reimbursement determinations; assess whether survey and certification processes offer adequate safeguards against unnecessary antipsychotic drug use in nursing homes; explore alternative methods to promote compliance with federal standards regarding unnecessary drug use in nursing homes; and take appropriate action regarding the claims associated with erroneous payments identified in the sample.
The CMS agreed with the recommendations except for the one that it facilitate access to information because a diagnosis is not a required data element for billing or required for prescriptions.
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