From the U.S. Government Accountability Office, www.gao.gov Transcript for: Doctor Shopping in Medicare Part D Audio interview by GAO staff with Gregory Kutz, Director of Audit Services, Forensic Audits and Investigative Service Related GAO Work: GAO-11-699, Medicare Part D: Instances of Questionable Access to Prescription Drugs Released on: October 4, 2011 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the Government Accountability Office. It's October 4th, 2011. When Medicare patients "doctor shop" (seeing several doctors and pharmacies in order to receive more of a drug than was intended by any single physician), it can jeopardize patient care and result in increased cost to taxpayers. A group led by Greg Kutz, Director of Audit Services in GAO's Forensic Audits and Investigative Service team, recently reviewed issues surrounding doctor shopping and Medicare Part D. GAO's Jeremy Cluchey sat down with Greg to learn more. [ Jeremy Cluchey: ] Your team in this report looked at the extent to which Medicare beneficiaries were doctor shopping for frequently abused drugs. What did you find? [ Greg Kutz: ] Yeah, we took a look at Medicaid in 2009 and found doctor shopping in several states, and so Senator Carper and Senator Brown asked us to take a look at doctor shopping in Medicare Part D and we found some of the similar types of things going on across the country. One hundred seventy thousand cases of potential doctor shopping or indications of doctor shopping for individuals in the program, which were the 14 classes of drugs that we identified, represents about 1.8 percent of the people purchasing those drugs. And we're talking about things like Vicodin, Oxycontin, Ritalin; some of those popular drugs that are really very frequent and popular drugs used kind of in the national epidemic of prescription drug abuse. We looked at several states of cases and we found people going to as many as 58 different pharmacies and 45 doctors for the same drug or same class of drug within the period of calendar year 2008. So clearly getting more drugs than was necessary for their personal use. And we went and talked to the doctors in some cases about what was going on. They were unaware that their patient was getting these drugs from other doctors at the same time. So in a month you may see a person go to 3, 4, 5, 6, 7, or 8 doctors, multiple pharmacies, getting drugs like Oxycontin, Hydrocodone, Oxycodone, etc. Again, we don't know for sure whether they were dealing the drugs, but in most cases indications are these are drug addicts. [ Jeremy Cluchey: ] You also looked at what the Centers for Medicare and Medicaid are currently doing to try and curb this issue. Can you talk about those steps? [ Greg Kutz: ] Right, they really are doing some drug utilization reviews by the Medicare MEDIC which is the integrity contractor, and then the plan sponsors. The problem with what's being done right now is they are sending [inaudible]. Several of the 10 cases we looked at we saw evidence that the letters were going out to doctors saying that these people were doing doctor shopping (going to multiple doctors for the same drug), but the only thing that the doctors would do is perhaps drop the patient. There was no other consequence. So really for the beneficiary who's doing doctor shopping, they could simply either switch doctors, add new doctors, or even switch plans. [ Jeremy Cluchey: ] One recommendation that GAO's making in report is that CMS considers steps such as a restricted-recipient program. Can you talk a little bit more about this? [ Greg Kutz: ] Yes, this is a proven method in the Medicaid program in the private sector where an individual who's a known abuser of the system is limited to one doctor, one pharmacy, or both—meaning we're not cutting your drugs off, but we're limiting how often you can go and where you can go so it really would cut off doctor shopping like I've just described it. The other recommendation really relates to with respect to that, making sure that the plans' sponsors share information. So I mentioned earlier that you can actually switch plans frequently, so if you don't have sharing of information about known doctor shoppers between prescription drug plans and sponsors, then people can simply...they get caught in one program, can move to another program. So the other recommendation is if you do a restricted-recipient program, then you need to make sure and share that information about doctor shoppers between the plans so the new plan that they move to is aware up front what they're doing. [ Jeremy Cluchey: ] And for taxpayers concerned about fraud and abuse in Medicare Part D, what's the bottom line in this report? [ Greg Kutz: ] I'd say there are two bottom lines. I mean the first one being with respect to waste of government resources. This is certainly something that is another part of the bigger issue of health care fraud in our country. This is a little teeny piece of it, but it's still important. But probably the more important part is the nature of the drugs we looked at. We looked at 14 of the most frequently abused prescription drugs as part of the evidence out there with this national epidemic of drug abuse. So the real issue to me is the safety of these patients and federal government programs feeding drugs into the nation's drug abuse problem and that's probably the more important reason why CMS needs to take some actions to try to prevent this from happening. [ Background Music ] [ Narrator: ] To learn more, visit GAO's website at gao.gov and be sure to tune in to the next edition of GAO's Watchdog Report for more from the congressional watchdog, the Government Accountability Office.