At a congressional hearing Tuesday, lawmakers pummeled CMS officials with questions about lax oversight and complaints that Medicare fraud could be contributing to opioid abuse.
Dr. Shantanu Agrawal, the CMS' deputy administrator and director of Center for Program Integrity, says the agency is moving as quickly as possible to shore up oversight of the Medicare Part D program and put in place suggestions given by HHS' Office of Inspector General.
Since 2006, the OIG has repeatedly asked (PDF) the CMS to require plan sponsors to report all potential fraud and abuse to the CMS, report data on the inquiries and corrective actions they take in response to incidents of fraud and abuse, and restrict certain beneficiaries to a limited number of pharmacies or prescribers.
“These are commonsense recommendations,” Rep. Tim Murphy (R-Pa.), chair of the House Energy and Commerce Subcommittee on Oversight and Investigations, said at the hearing. “The CMS' failure to implement these recommendations has led to trends of questionable billing associated with pharmacies, prescribers and beneficiaries.”
The OIG also said that it was pushing for the prosecution of bad actors in the Medicare Part D program and has even beefed up its task force on the matter, but that the CMS needed to step up its efforts as well.
“We cannot arrest our way out of the problem,” said Ann Maxwell, assistant inspector general for evaluation and inspections at the OIG.
Lawmakers on Tuesday also connected Medicare Part D fraud with increased opioid abuse. This month, the Centers for Disease Control and Prevention released a report that found Americans are becoming "primed" for heroin addiction through the growing use and abuse of prescribed opioid painkillers. Murphy noted that some of the questionable billing the OIG found was tied to commonly abused opioids.
A further look at Medicare Part D data revealed that between 2006 and 2014, the total number of beneficiaries receiving commonly abused opioids grew by 92%, compared with 68% for all drugs, Murphy said.
Before Agrawal could address his agency's role in the problem, he was issued a strong warning.
“Don't tell me you're overworked, don't tell me you don't have enough money, when you got a job to do, you work until the job is done,” Rep. Marsha Blackburn (R-Tenn.) said. “You don't deserve more money, because you not taking good care of the tax dollars now coming your way.”
Agrawal didn't say resources were to blame for not fully adopting the nine OIG recommendations. Instead, he noted that substantial steps have been made to implement all of them.The issue is that each recommendation will require multiple steps to implement and that takes time.
He was hesitant to give a timeline on when all nine recommendations would be fully addressed, but did indicate several steps would be taken by next summer. The agency is working toward a January 2016 deadline to enroll more than 400,000 prescribers of Part D drugs into Medicare. The goal is to ensure that Part D drugs are prescribed by qualified individuals.
“Requiring prescribers to enroll in Medicare will help the CMS make sure that Part D drugs are prescribed by qualified individuals, and will prevent prescriptions from excluded or already revoked prescribers from being filled,” Agrawal said.
On the matter of drug abuse, the CMS has been providing information to plan sponsors about Part D enrollees who have potential opioid or acetaminophen overutilization that may present a serious threat to patient safety.
“We need to take a closer look at these numbers and make sure that this program is not contributing to this devastating epidemic,” Agrawal said.
However, he warned that Congress should be leery of pushing an overly prescriptive policy to address opioid abuse, noting that there are people who genuinely need the drugs as part of their treatment.
