While the main focus of Medicare has historically been to provide affordable and accessible medications to seniors, its focus has recently changed. Early this January, The U.S. Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would bring significant changes to the federal agencies.
The most notable change offered by the proposal is the agency’s new authority to kick out physicians and other providers who engage in abusive prescribing. It could also take such action if providers’ licenses have been suspended or revoked by state regulators or if they were restricted from prescribing painkillers and other controlled substances.
Additionally, the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program (known as Part D) even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people in Part D. This requires them to verify their credentials and disclose professional discipline and criminal history.
Critics have long alleged that the agency’s handling of fraud claims was poorly managed and oftentimes overlooked many so-called scams, but representatives for the agency assert that it has always taken fraudulent activity seriously. However, these new rules will ensure a harsh crack down on any illegal or unethical practices.
Under the new plan, Medicare’s outside fraud contractor has the ability to more easily investigate suspicions of fraud. Currently, the contractor cannot directly access patient medical charts to assess whether the patient actually saw the doctor or had a condition that warranted the medication. The contractor must go back to the insurers, then request the records from doctors or pharmacies. Under the rule change, the contractor would be given the power to access the records directly.
The changes would take effect Jan. 1, 2015. As part of the process, CMS will accept public comments until March 7 and could revise the proposals based on the feedback.
