OIG Concerned about Part D Schedule II Drug Reporting

On February 2, 2011, the OIG published its findings from an audit conducted of Prescription Drug Event (PDE) records obtained from Medicare Part D sponsors for Schedule II drugs. A copy of the report can be found at: http://go.usa.gov/Ydd. A significant number of PDE records contained invalid prescriber identifiers which accounted for approximately $20.6 million in gross drug costs in 2007. Moreover, due to limited guidance and edits in place for the prescriber identifier field, the OIG was unable to identify the names of the top prescribers for three high abuse potential drugs: oxycodone, Ritalin, and methadone. The OIG made certain recommendations to CMS to address this matter and CMS is in the process of doing so in order to properly monitor and oversee the Part D program to detect, prevent, and control fraud, waste, and abuse.

The OIG has had a growing concern regarding the fraudulent prescribing of Schedule II drugs and is aware of numerous illegal practices including prescribing without a legitimate doctor’s office visit, prescribing without a legitimate medical purpose, and collusion with the pharmacy. The attorneys at The Health Law Partners have a significant amount of experience in the defense of health care fraud investigations, staff privilege matters, overpayment demands and licensing matters arising out of allegations involving Schedule II drugs. For more information regarding such matters, please contact Robert S. Iwrey, Esq. at (248) 996-8510 or (212) 734-0128 or riwrey@thehlp.com.