Medicare fails to monitor questionable prescribing practices, investigation finds

BMJ 2013; 346 doi: (Published 15 May 2013) Cite this as: BMJ 2013;346:f3184
  1. Michael McCarthy
  1. 1Seattle

An independent investigation of a government database has identified doctors and other health professionals who are prescribing worryingly large quantities of opioids, antipsychotics, and other drugs to elderly and other patients through the Medicare prescription plan.

Although the database makes it easy to identify practitioners who are prescribing large amounts of “potentially harmful, disorienting or addictive” drugs, federal officials “have done little to detect or deter these hazardous prescribing patterns,” the investigators report.

The investigation was conducted by ProPublica, an independent, non-profit investigative journalism organization, and was published on ProPublica’s website and in the Washington Post on 11 May.1

In the investigation ProPublica reporters Tracy Weber, Charles Ornstein, and Jennifer LaFleur analyzed prescriptions covered through the Medicare prescription plan known as Medicare Part D.

The ProPublica team gained access to the data, which provided the prescribers’ but not the patients’ names, under the Freedom of Information Act.

Their analysis found, for example, that about 70 providers being reimbursed through the system had each written more than 50 000 prescriptions and refills in 2010, an average of 137 a day.

The investigators also found that half of Medicare’s top prescribers of extended release oxycodone in 2010 had been charged or convicted of crimes, had settled fraud claims, or had been disciplined by their state medical boards.

“Similarly, eight of the top 20 prescribers of 30-milligram oxycodone pills—the strongest dose—have been charged, convicted, or barred from prescribing controlled substances, or face discipline by licensing boards,” the investigators wrote.

The article reported officials at the Centers for Medicare and Medicaid Services (CMS) as responding to the investigators’ findings by saying that the job of monitoring practitioners’ prescribing practices fell to the private health plans that administer the program and that Congress had not given the agency authority to question doctors’ prescribing practices.

But in a statement released in response to the investigation the CMS said, “The safety of Medicare beneficiaries and the integrity of the drug benefit are paramount concerns for CMS. Accordingly, we have multiple systems in place to promote safety and prevent and capture fraud. We constantly review our policies to ensure the program is as strong as possible, and the ProPublica article highlights areas of concern and additional steps worth considering.”

As part of the project ProPublica created an online application ( that allows anyone to search the database and learn what drugs any healthcare provider prescribed through Medicare Part D in 2010 and to compare their prescribing practices with those of other healthcare providers.


Cite this as: BMJ 2013;346:f3184