Review: Funds may have gone to Rx abuse

Millions of taxpayer dollars are being spent on prescription painkillers for state Medicaid recipients who jump from doctor to doctor to get their drugs -- a sign of possible abuse.

The state Department of Health reviewed prescription data from the first six months of 2010 and found 46 percent of oxycodone prescriptions paid for by Medicaid went to possible doctor shoppers -- people who'd filled prescriptions from two or more doctors at two or more pharmacies in a month.

The state spent $66.7 million in Medicaid funds on oxycodone in 2010. If 46 percent of that amount went to potential doctor shoppers, $30 million was spent on drugs for possible oxycodone abusers last year.

Doctor shoppers often avoid detection by alternating Medicaid and cash to pay for their drugs, and state officials don't know how many millions of dollars in bogus Medicaid claims are slipping through.

However, Medicaid officials monitor prescription pill records for signs of possible doctor shopping and collect that information on a database, which managed to save taxpayers an estimated $150 million last year, said Wanda Fischer, a spokeswoman for the state Office of the Medicaid Inspector General.

"It's an insult to our taxpayers that their hard-earned money is being used for fraudulent purposes," said Nassau Social Services Commissioner John Imhof, whose department administers the county's $1.6 billion Medicaid program.

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Drug abuse on the Island

The problem of doctor shopping and prescription pill abuse became evident on Long Island this summer, when David Laffer was arrested and later pleaded guilty to murdering four people in a Medford pharmacy and stealing thousands of pills.

Newsday reported last month that Laffer and his wife, Melinda Brady, visited dozens of doctors in the four years before the murders. The couple got prescriptions for thousands of pain pills, often filling several a month, records show. The couple paid for their drugs with private insurance and cash, not Medicaid.

Last month, Stan Li, a New Jersey doctor with an office in Queens from whom Laffer and Brady received numerous prescriptions, was arrested and charged with criminal sale of prescriptions and reckless endangerment in connection with the overdose death of a Queens man under his care. Li is also under scrutiny by city narcotics investigators for Medicaid funds he received, officials have said.

On Wednesday, state Attorney General Eric Schneiderman announced the conviction of a Bronx woman who led a crew that forged narcotics prescriptions and paid for them with Medicaid at pharmacies across the state. The scheme cost taxpayers $200,000 since 2009, Schneiderman's office said, adding that more of the phony prescriptions were filled at Nassau County pharmacies than any other county in the state.

Millions in taxpayer costs

New York consistently ranks first among states in Medicaid spending. Including federal funds, the state's Medicaid program cost $54 billion last year.

Prescription payments are a fraction of overall costs. In Nassau, 6 percent of the $1.6 billion spent on Medicaid buys prescription drugs, Imhof said. But given the size of the state program, even a small percentage going to doctor shoppers represents millions of dollars in taxpayer expenditures.

Nassau and Suffolk officials issued warnings last year about a spike in the number of Medicaid-backed prescriptions for OxyContin, a brand-name pain medication that contains oxycodone. In 2009, there were 1,360 such prescriptions in Nassau -- an increase of 258 percent since 2007. In 2010, there were 2,301 Medicaid prescriptions for OxyContin in Nassau, a 69 percent increase over the previous year.

On Long Island, oxycodone has been linked to more overdose deaths last year than heroin, according to medical examiner records.

Monitoring prescriptions

Under the state monitoring system, whenever someone uses a Medicaid card, the information is recorded in a database. As soon as the database flags a recipient as a possible doctor shopper, the recipient's use is restricted to one doctor and one pharmacy and, in some cases, one hospital. Any attempt to use the card elsewhere results in the card being rejected. Drug seekers trying to get around these safeguards may alternate use of Medicaid cards with cash.

County officials said 292 people in Suffolk County and 201 in Nassau identified as possible doctor shoppers by the inspector general have had their Medicaid use restricted.

Scott Skyrnecki, director of Nassau's Medicaid fraud investigation unit, said Medicaid appeals to drug users and dealers because there are no upfront costs -- dealers can get product for free as opposed to illicit drugs like heroin that require a significant outlay of cash.

In recent years, the state Health Department has looked at several changes to prescription drug monitoring in an effort to cut down on abuse and save money. The department recommended to a Medicaid redesign team formed by Gov. Andrew M. Cuomo that prescribers be required to check a doctor shopper database before writing a prescription.

It was in this proposal that the department released its analysis that 46 percent of Medicaid-funded oxycodone prescriptions in the first six months of 2010 went to possible doctor shoppers.

The database can catch doctor shoppers who alternate between cash and Medicaid, but checking it is voluntary. The proposal -- one of more than 4,000 the redesign team received -- was not adopted.

Cuomo's office directed questions to the health department, where spokesman Jeffrey Gordon was unable to say why the proposal was not adopted.

Gordon said state officials are "developing a comprehensive approach" to deal with doctor shopping and Medicaid abuse. He said the state has not conducted a more comprehensive review of the relevant data. No figures on other drugs or years are available, he said.

Paul Howard, director and senior fellow at the Manhattan Institute for Policy Research's Center for Medical Progress, a conservative think-tank that advocates for market-based approaches to health care reform, said protecting public money is just one reason the state should analyze its data to determine the full impact of doctor shopping in Medicaid.

"It should be done as a routine matter," Howard said. "But also from a public health perspective, if these people are addicts and drug abusers, that needs to be captured as well, both to improve health and control spending."