Controlled Substances at Center of Medicaid Fraud Probe

A new government report has uncovered 65,000 apparent cases of “doctor shopping” for controlled substances in five states that amount to Medicaid fraud, Becker’s Hospital Review reported Oct. 1.

The study from the U.S. General Accounting Office (GAO), Medicaid: Fraud and Abuse Related to Controlled Substances Identified in Selected States, found that tens of thousands of Medicaid beneficiaries obtained prescriptions for controlled substances from six of more physicians in 2006 and 2007. The purchases cost Medicaid an estimated $63 million.

Some of the purchases were legitimate, such as obtaining prescriptions from multiple members of the same medical group. But there also were many cases where Medicaid recipients got controlled drugs from illegitimate sources or were suspected of obtaining the drugs for illegal resale. Pharmacies also filled prescriptions for more than 1,800 Medicaid beneficiaries who were dead at the time, the study found.

The GAO recommended that states — which administer their own Medicaid programs — use their claims-processing systems to exclude pharmacies that have been excluded from the Medicaid program for violations, prevent doctor-shopping by Medicaid recipients, and gather updated information on the death of Medicaid patients to prevent abuses.