About 400 Medicare prescribers questionably ordered opioids for beneficiaries at serious risk of misuse or overdose, according to a recent Health Department (HHS) Office of Inspector General (OIG) report, but one expert says punishing these physicians might not be the best solution to the problem.
“There are doctors out there who are prescribing a large amount of opioids, not because they are trying to defraud the government, because they have a sincere belief when they have a patient coming to them with pain or chronic pain that it’s better to manage that pain through opioids than not," said Sam Hammond, poverty and welfare policy analyst for Niskanen Center.
Hammond said these doctors often have a whole range of services they offer other than prescribing painkillers, so taking away their right to practice might be a step too far.
Rep. Danny Davis (D–IL) agreed that punishing these physicians should be a last resort.
“You wouldn’t want to see all of that training and all of that potential go to waste if it can be salvaged,” Davis said.
Over 115,000 Medicare prescribers were said to have ordered opioids for at least one beneficiary at serious risk of misuse or overdose, according to the report, but the 400 prescribers were found to be far outside the norm.
“My worry is that if we focus too heavily on the extreme cases we’ll miss out on the fact that there is a pervasive and systemic problem in how we’re prescribing opioids," Hammond said.
The OIG released the identification numbers of 270 of the 400 prescribers, and of those provided, the top five states with prescribers listed as questionable were Arizona, North Carolina, Tennessee, Texas and Florida.
And almost nine percent of the prescribers provided had previous actions on their medical license. A few were simply for not renewing their license, but others were disciplinary actions related to prescribing issues.
For example, one prescriber in Texas that was identified in the report had their license restricted in 2002 for ordering narcotics for a patient who was "known to be an abuser of narcotic drugs," according to the Texas Medical Board's physician profile.
Then, in 2015, that same prescriber was publicly reprimanded for not properly monitoring or keeping records of patients he was treating for chronic pain. His medical license is still active, according to the Texas Medical Board's website.
Hammond said that instead of taking away medical licenses, there are multiple ways to “crack down” on the prescribers.
“One would be to go through the Justice Department and the FBI ... another way would be for the Center of Medicaid and Medicare Services to put in restrictions and guidelines about how you can be reimbursed for opioids to prevent this sort of incessant prescription of opioids," he said.
The OIG said the list does not confirm that the prescribers were engaging in illegal or abusive practices, but they do warrant further scrutiny. The OIG plans to work with the Center for Medicaid and Medicare Services (CMS) and law enforcement to follow up on the prescribers.
CMS said they are working with stakeholders to address the opioid epidemic and to find alternative solutions to pain management.
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