The American Recall Center/Medicare Part D
by – Sheri de Grom
Doctor Writing Prescription – Morgue File
How can one doctor continue to write an excessive amount of prescriptions, and have them filled—151 times more than the average doctor’s tally for all Medicare patients—and not have it raise a red flag? The cost to the government was $9.7 million.
Pro Publica’s investigative reporters analyzed four years of Medicare prescription drug data and examined the prescriptions of all health professionals across specialties. It examined all prescriptions—1.7 million in 2010 alone—not just those in general-care specialties or mostly urban areas.
Medicare’s prescription drug program was launched in 2006 and now accounts for one
Medication Prescribed – Getty Photo
in four prescriptions dispensed, according to the Inspector General. Last year the government spent $62 billion subsidizing the drugs of 32 million people.
Medicare has failed to protect patients from doctors and other health professionals who prescribe large quantities of potentially harmful, disorienting or addictive drugs. It’s impossible to maintain medication safety for the Medicare population when a government agency turns a blind eye to the needs to a vulnerable population.
I rarely agree with anything Senator Tom Coburn (R) of Oklahoma comments on and his voting record reflects an extreme right approach. However, I do agree with his statement, “No one wants Medicare telling doctors which drugs to prescribe. But, the government does have a responsibility in preventing fraud and abuse.”
Medicare Difficult To Understand – Getty Photo
The Office of the Inspector General of the Department of Health and Human Services has repeatedly directed the Center for Medicare officials to be more vigilant. Yet the agency has rejected several key recommendations as unnecessary or over-reaching.
Pro Publica has created an online tool at this location. Click on the link to search for individual providers and see which drugs they prescribe.
Nursing Home – Unable to Hold on to Conversation – Getty Image
After I retired from government, an advertisement for a Chief Financial Officer for a group of nursing homes in North Carolina caught my eye. I knew from previous investigations that the abuse of pharmaceuticals as money-makers was wide-spread but I had no idea how bad it was in the civilian sector until I accepted this position.
The prescribing practices I found the most deplorable were for profit margin and not for the benefit of patients.
A private practice psychiatrist visited the facility once a month and fraudulently annotated in the patient charts to reflect he had assessed the patients for the high levels of pharmaceuticals he prescribed. Each note in a patient’s medical chart was billed as an office visit by the doctor, resulting in a hundred or more office visits per day. The doctor visited five nursing homes each month and he billed for 300 patients per nursing home. This doctor did not need to maintain an office, he made his fortune via fraudulent billing.
Pharmaceuticals had the largest profit margin of any other department at the group of nursing homes where I was employed and anti-psychotics were prescribed two to one over any other drug.
I hadn’t been hired by the nursing homes’ corporate office to investigate pharmacy, Medicare, or other types of abuse. I’d been hired to look for new sources of revenue and to collect back debt.
I couldn’t allow the patient population to receive excessive sedating drugs. The patients included: the elderly, veterans, the disabled needing extensive physical therapy and hospice patients. It’s no wonder the patient population seemed more confused, became agitated and fell often creating even more work for an industry that’s routinely under-staffed.
White Collar Investigation
Getty File
Thankful, for many reasons, I don’t have Medicare Part D for my prescription coverage and I’m grateful a portion of my health-care coverage has stayed almost level. I’m still able to use my same independent pharmacy where we’ve had prescriptions filled since we moved to our home eight years ago.
It’s no wonder medications are so costly today. The United States is the only country in the civilized world that charges its consumers the cost of research and development for every brand name drug sold.
Additionally, Congress has served up a blank check to pharmaceutical companies for Medicare Part D. It prohibits Medicare from negotiating with companies for lower prices. Medicare places no cap on the cost of medications they approve and these results in the patient having a higher co-payment.
Medicare might benefit the patient if it allowed the same negotiating of payment policy with physicians and other healthcare services.
What do you think? Will Medicare Part D be what you need when it’s your turn to need pharmaceutical coverage?
Congress and Medicare gave the pharmaceutical companies a blank check with our tax dollars held for ransom. Why is this okay with Congress, the Presidential Administration and the Supreme Court? This is not equal opportunity, it’s not safe medicine and it’s not justice!
Thank you for reading with me. I always appreciate you support. The month of October marks the calendar as “Talk About Your Medicines” month. I’m honored that www.recall.com/community asked me to be an extension of their campaign. Please visit their site.
Sheri Lawrence de Grom 
Sheri, your blogs are filled with the most relevant and detailed information of any I read (and I read a lot!). Thank you for the obvious research you do to make certain your followers learn from every single post. You are amazing!
Thank you, Patricia. Yes, research requires a great deal of time but I learn and learn and that keeps my mind active. It’s amazing how blogging and advocacy work go hand in hand. If I weren’t doing the research for my blogs, much of it would have to be completed for my advocacy work. I appreciate your reading with me and your comments are always appreciated.
During the summer conference for my occupation, I attended a retirement seminar and Medicare was a huge topic. If we can keep our regular insurance, we need to make sure we aren’t signing off on it in order to get something sub-par.
Thankfully, I only take vitamins, and I worry about those sometimes.
Renee – You are correct in keeping your own insurance if at all possible. Medicare will still cast it’s net and you end up paying for coverage you don’t need but I’m not about to let our Blue Cross/Blue Shield plan go that followed me into retirement from government service. Of course I pay a lot more for it now but when I hear what others are paying for prescriptions alone out of pocket plus co-pays for what Medicare Part B doesn’t cover. Tom and I don’t need Medicare coverage nor do we want it. At the present time, there’s no exception to the rule unless you are the president or a member of congress!
Sheri – Thank you for this blogpost. Dishonest doctors are a shame. Awareness and education – it is all we need, and thank you for both.
I am grateful for medical professionals, and I am grateful that my daughter lives in your country and has an access to the best medical care. I have been prescribed the same antibiotic for any infection over the years. I appreciate that medical science is more advanced in your country. As I said – awareness and education are essential until dishonest professionals keep stealing our money and ruining our health.
My best wishes,
Inese
Inese – I understand about the same antibiotic being prescribed for a patient over and over. This practice is out of hand the world over. We have an overuse of antibiotics around the world and if our medical profession and FDA don’t come up with stricter reinforcement codes, we will not have antibiotics to actually fight bacteria when we need them. The Agra-industry has used excessive antibiotics for decades in promoting growth and we’ve seen what that does to the meat in the butcher’s case. I have a blog coming up in the near future about my own battle with community acquired MRSA and the battle to even find someone that would help me fight it, let alone help me get something that would make the infection go way.
Have a great week and I’ll be checking in later. Sheri
Sheri – yes, antibiotics have been misused for years. They are pretty specific, it is why I am annoyed when they are prescribed inadequately.
Have a great week you too!
Inese
Sheri, I’ll read this post this week when I’m back from vacation. But I have been meaning to offer connecting you with my husband because you two are walking the same terrain. Let’s DM on Twitter so I can give you his direct contact information, if not for now, for when the time arises. Awesome work on a very tough topic, Sheri.
Angie – Have a great vacation and I’d love to hear your husband’s view point on the subject. I’ll continue to watch my DM basket. Sheri
Awesome! DMs posted 😀
Thanks for an informative post. Not all doctors are the same, but when money-for-jam is involved, many will be tempted, even if it involves fraud. Prosecution is an important tool, but that’s another story.
I suspect the same goes in all areas of life where “free money” is available.
Hi, Lignum – You’re completely correct. As my father used to tell me, ‘If I leave the barn door open, I’m inviting someone else to take the hay I’ll need to feed my animals all winter.’ It’s been many years since I’ve had to worry about caring for large animals but the principle is the same. Some doctors cannot keep their hands out of the ‘cookie jar.’ In government investigations, we found the majority of doctors committing fraud were the ones with the highest pay grades and the most to lose if they were caught. You mentioned the issue of prosecution and yes, that’s another story. In what I call the ‘real world’ anything that’s beyond governmental, it was up to us as investigators to have a prosecutors case laid out for them complete with legal citations before they would consider pressing charges. Within government it was easier. Once we were able to prove the crime was committed and we had solid evidence, often we were able to watch head’s roll and others went to court martial and such. Others were allowed to retire with full pension (and I still don’t understand that one).
Sheri, another important post for you. Though we don’t have this system over here, I’ve still seen over-prescribing of medicines to the elderly people in my family.
Hello Andrea and it’s so nice to have you stop by. Were you able to stop or modify the over-prescribing of the medications to the elderly in your own family. I haven’t seen a pharmacy distribution center clean of fraud of misuse and re-distribution since I started my career in 1980. My team and I traveled the world researching this issue for the World Health Organization and no one passed the regulatory requirements. In most countries the corruption occurs when the doctors manage to write orders for illegal drugs to go in their direction! We learned the larger the pharmaceutical distribution points were losing billions of dollars each year from in-house theft.
It took so long to get my mother’s medications right and not having the knowledge, there may have been things she didn’t need. Quite often it was the pills that are seen as less dangerous – like the lower level painkillers, but of course they’re just as dangerous if you take the wrong dose.
Andrea – It’s so hard to get medications exactly right, no matter how hard we try. It really is a give and take. Only yesterday Tom’s neurologist wanted to prescribe something to relieve his discomfort with the awful migraines he has. Most of what is available he cannot take due to coronary issues and others interfere with his psych meds. I liked this doctors approach. He wrote out a simple memo [I couldn’t remember when I’d last saw a doctor actually write something] to 3 doctors he wanted answers from. Then, instead of using the medical communication system, he gave the note to Tom who of course passed it to me. I’m to find out from the cardiologist, endocrinologist and psychologist if the medication is okay for Tom to take for pain relief. This approach leaves Tom and I in charge of getting the answer as fast as we can and also getting the answer back to the neurologist so perhaps Tom can have some relief. It is such a delicate balance.
Thank you, Sheri, for another informative post. My only experience with this was when my elderly father-in-law needed help while on vacation with us in dispensing his meds. I volunteered and OMG, I could hardly understand it nor keep track of it. He was taking so many pills, it was unbelievable and I know that’s typical. And he was seeing so many different doctors and I don’t think the hand knew what the arm was doing. And you can’t count on the pharmacist to monitor it either. What a morass of confusion. I do not think our insurance will change when my husband retires due to the type of benefits he has so our $5 copay will supposedly remain. We’ll see.
Patti – Please read your policy when it comes up for renewal this year and each year to come. Many changes are coming and I don’t want you out in the cold. I hope to have a blog up in the near future regarding this very subject. Double check to see which medications will remain under your $5 co-pay. Generics that are now called split-generics are being called brand-name medications. It pays to read the fine print. I haven’t seen a single policy that hasn’t changed for 2015.
sheri, this is all so true. i’ve lived it with my grandmother and my mother as well –
Beth – Not only true but scary. These medications can and do bring on premature deaths.
I don’t believe in taking too many pills, I’ve seen too many people that were over-medicated and even told a few to double check exactly what they were taking. But, next year when I’m actually on Medicare – I’ll be back here trying to make heads or tails of the system.
Tom tells me I’ve been in the South too long when I say, “Well, bless your heart,” but that’s how I feel about anyone heading into the Medicare crisis. I know many areas of the VA are accused of over-medicating patients (especially pain medications). My game plan for Tom and I is that I keep a running tally of all the meds we take [color coded to meet Tom’s requirements] and there I cross reference every medication we take. Of course Tom never takes anything new until I clear it with his psychiatrist.
Very good and tell Tom it is quite refreshing to hear a “Bless your heart” once in a while. 😆
Hoping to hear soon about Tom’s DC visit, we have radar – I was just about to email you today and ask how everything went!!
Glad you are there to advocate for justice.
Me too, Gallivanta. Often I feel as though I’m pushing a monkey cart up the hill backwards.
Sheri, thank you so much for continuing to educate and inform us. You are truly a blessing.
Thank you, Ruth. We’re learning together how to navigate this business of health care that’s become a reality in our complicated world.
Sheri – This is very painful and devastating problem. I am shocked. But I had to say our Medical system in Israel, seniors are much better.
10 things Medicare won’t tell you:
1) “We’re in the cross hairs like never before.”
2. “Think Social Security is broke? Just look at Medicare.”
3. “Marketing isn’t our strong suit.”
4. “Don’t expect a five-star plan.”
5. “We’re not popular with many doctors.”
6. “We get ripped off a lot.”
7. “We don’t cover a lot of the care seniors need most.”
8. “And you’ll pay for the coverage we do provide.”
9. “Paws off that cash, Grandpa: Your settlement is ours.”
10. “Did we turn you down? Keep trying.”
Mihran – This is a perfect list – Sad but true. Not a single line item can be removed. Brilliant!
OMG. So fraud is intolerable! Dangerous to patients. Isn’t it illegal as well? I’m gobsmacked. Can’t get my head around it. What happened to the Hippocratic Oath: cause no harm or something like that? 😮
Tess – You aren’t the only one that has a hard time wrapping their head around this issue. Yes, everything I’ve witnessed is dangerous to patients, it holds nursing home’s responsible as they are the ones that dispense the medications and often don’t have adequate staff to keep patients from falling. I recently went through this very thing with Tom while he was in the hospital and that’s another thing I want to blog about.
The only solution I’ve come up with so far is staying by Tom’s side and checking every medication someone has ordered. It’s a mad, mad world, my friend.
My mother always used to say she didn’t want to be put into a home of any kind because for sure it would kill her. Thank goodness, we didn’t have to do that.
Tess, I’m so glad that your mother didn’t have to go that route also. My mother passed of a cardiac arrest at home and that’s always hard on the family but far better than the alternative of lingering on and on. Mom would never have made a good patient and she told her doctor after her last open heart surgery that she was going home to enjoy her grandchildren, garden and spend as much time as possible with my father. She did those very things.
My mother knew when her days were numbered and it was painful knowing that she knew. ❤
My father also knew and yes, I understand about the pain.
❤ ❤ ❤
The United States is the only country in the civilized world that charges its consumers the cost of research and development for every brand name drug sold. We’re the only country in the world that lets Big Pharma get away with this. It’s all about profit, and not about the well being of people buying their drugs…
Don – Yes, yes and yes again. BigPharma has become the same as BigAgra – they are both poisoning our bodies. The FDA has the power (but they won’t use it) to step in and put a stop to all of this – but they haven’t since the ’70’s [and then they pulled back when their budget was cut]. Both agencies have never been about the people but about profit and loss statements.
When I worked in the pharmacy I was shocked to see the fraud that happened. People going to different doctors, primary, ER, clinics to get scripts and fill them with no questions asked from pharmacies. Most pharmacies are better now than they used to, but it is hard to keep up with the creeps out there
Terry – Hello and it’s nice to see you here. I’ll admit we have as many bad patients abusing the systems as we have physicians writing prescriptions when they shouldn’t. It’s my understanding a new system is in place where all narcotics have to be written out by the doctor and hand carried to the pharmacist every 30 days to have the prescription filled. It’s going to be tough to get around the doctor feel-goods of the world.
Another really good and important post. My sub-speciality when in grad school at UCLA was gerontology. One of the biggest problems with that population was/still is polypharmacy. The problem extends to “do I eat” or “buy my meds” and then there’s all the adverse reactions of combinations and over prescribing. I’ve said enough. On a lighter note, Cindy’s answer made me smile, chocolate! Wishing you and your husband well, Sheri. Love, Paulette
Paulette – Yes indeed, fine chocolate is a mighty reprieve from what ails a person, when in distress. You’ve hit on one of my big concerns with the elderly population: do they eat or buy their meds. I’ve seen this human suffering problem many times over and we have to have relief from this situation. For the most part, these are individuals that have worked hard their entire lives and this is the choice we give them. Not acceptable in my opinion.
I truly am scared by this!
We all need to be aware of what is happening and know it could happen to not only the elderly individuals now in our lives but our future as well.
It is ridiculous the cost of medication. When I was diagnosed with pulmonary hypertension the medication I needed wasn’t covered by my insurance. I was able to get it free through Pfizer. It cost over $3,000 for a month supply. But if I was a man I could get it free in clinical trial for erectile dysfunction. I needed it to save my life but men could get it free so they can have sex. Does that make any kind of sense?
No sense at all. Medications, such as the one that is life saving for your condition, should be an automatic given, in my opinion. An example I’ll provide has to do with myself. I have narcolepsy and other than going to sleep many times when I would have preferred to be awake, I’ve also totaled a number of cars. The medication that fights my narcolepsy went generic a couple years ago and it did nothing to keep me awake. My PA fought the gallant fight and the insurance company came through for me to receive the original formula. We have to go through the same battle every six months but it’s worth it to me.
Definitely for you and the rest of us who are on the streets when you drive. I guess it’s a way of ridding the world of the frail and poor. So that only the healthist, beautiful and rich survive.
Kim – I so agree with you. I spend hour upon hour researching what’s happening to our health care and finding exact percentages and other numbers relevant at the time I’m posting. It never ceases to amaze me from the time I write something until the time I actually post something, the numbers may have actually changed. It’s crazy making!
Thankfully, all of my auto accidents have been one car only. The last one sent me over an extreme mountainous edge in NC. Had I not been in a Volvo at the time, I would have been killed. That was back in 2000 when Volvo was still making the safest car on the road and when an accident occurred with certain trigger points, the passenger actually ended up protected in a steel cage. By the time I hit the ravine at the bottom of the mountain, all four sides of the car were smashed in, including the front and back of the car and needless to say a total loss.
I have a wonderful friend now that does most of my distance driving (just in case). The narcolepsy seems to strike when I’m under the most stress.
Dag . . . you be safe. I just got in from a long day I can’t think right now. I talk to you soon.
Take good care of yourself, Kim. Stay warm and maybe have something hot to drink.
Sadly I see this in my work continually. The elderly are often over prescribed and drugged. Not all doctors, by any means, do this. But it seems every community I work through seems to have at least one doctor known as a ‘pill mill’ or some other such aka. Not only is the government being scammed, the elderly are being abused by such doctors. Good points Sheri.
Oh yes. You are right, we have some fine and honorable doctors that treat their patients with the dignity and respect they deserve. However, it only takes a few with their hands in the ‘pill jar’ to make some of us sit up and take notice. We must collaboratively take notice and action at the same time.
That pill jar is one of the worst scourges on our society today.
Depressing. I prescribe chocolate. Lots and lots and then call me in the morning! Happy Halloween Sheri! 👿 Muuuaaaggg!
Cindy – Hello and a happy November to you. How did you know? Now there’s a 120 calorie serving of dark chocolate (all prepackaged for those of us that want to eat the entire contents of the bag knowing full well it will make us sick). It’s made by Whitman’s and there’s no aftertaste. I’m not on Weight Watchers but I do follow a diabetic path-way of carb counting and keeping caloric values in check. The reason I’m going on and on: if you know someone who believes they’ll just die if they can’t have a chocolate fix – check for the blue and white bag of WW chocolate pieces in the candy aisle. It’s around $4 and worth every pennny:)