PRESCRIBERS WITH QUESTIONABLE PATTERNS IN MEDICARE PART D

DHHS: June 18, 2013

WHY WE DID THIS STUDY

Under the Medicare Part D program, the Centers for Medicare & Medicaid Services (CMS) contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. In recent years, prescription drug abuse has emerged as a serious and growing problem. The Centers for Disease Control and Prevention has characterized prescription drug abuse as an epidemic. With the rise in prescription drug abuse, concerns about Medicare fraud, particularly prescriber fraud, have increased.

HOW WE DID THIS STUDY

We based this study on an analysis of Prescription Drug Event records. Sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the pharmacy, prescriber, beneficiary, and drug. We analyzed all of the records for drugs billed in 2009. We developed five measures to describe Part D prescribing patterns and to identify general-care physicians with questionable patterns.   Read more