CMS wants tighter oversight for Medicare prescriptions

Share this article:
Doctors warn against Aricept for dementia care, supplements for weight control in second annual 'Cho
Doctors warn against Aricept for dementia care, supplements for weight control in second annual 'Cho

The Centers for Medicare & Medicaid Services has seen enough and wants to gain more control over drug-prescribing practices for the Medicare Part D program.

The agency has issued a proposed rule that would give officials more power to regulate the issuance of drugs, including at nursing homes.

The new proposal squarely takes aim at prescribers. Among other things, it dictates that they would have to be fully certified by Medicare to have their prescriptions covered under Part D.

CMS officials explained that certification would help ensure that only “qualified individuals” are prescribing under Part D. They would be able to revoke Medicare certification of any prescribers found to abuse the system.

In the past, CMS has put responsibility for overseeing the Part D program largely on the shoulders of private health plans that administer it. The new proposal would shift responsibilities, which should boost efforts to fight fraud and abuse, agency officials noted. Under the proposal, they would be able to obtain prescription records, invoices and other items directly from pharmacies, rather than through Part D plan sponsors.

The tighter prescribing proposals are part of a 678-page rule that addresses a variety of changes for Part D and Medicare Advantage. It appeared in the Federal Register on Jan. 10.

CMS has hardened its stand on prescribers partly in response to abuses uncovered by the media. Investigative journalism group ProPublica, for example, published a major report in early 2013 that highlighted psychiatrist Enrique Casuso, M.D. He was the top antipsychotics prescriber under Medicare, even though the state of Florida had removed him from its Medicaid program in 2005.


Share this article:

More in News

Nursing home antipsychotic use has dipped nearly 19% under national effort, latest figures show

Nursing home antipsychotic use has dipped nearly 19% ...

The percent of long-stay nursing home residents receiving antipsychotic medication has decreased 18.8% under a nationwide initiative that started in 2012.

Jimmo succeeds in getting Medicare coverage, two years after landmark case ended

Glenda Jimmo has reached a settlement with the federal government and will finally receive Medicare coverage for claims that were denied in 2007, which led her to file a class-action lawsuit over the so-called "improvement standard."

Breier named new CEO at Kindred

Breier named new CEO at Kindred

Kindred Healthcare announced Thursday that it has chosen a new top executive to lead its push toward creating a mammoth national brand. Benjamin A. Breier, the company's current president and ...