Addressing the Phenomenon of “Pill Mill” Doctors

While the country seems to be in a constant debate about what effects legalizing or decriminalizing marijuana may have on our youth, it seems that not enough people are paying attention to the effects legal narcotics are having on our elderly — or how often physicians are prescribing them. Proactive pro- and anti-pot research is conducted everywhere from to basements to universities. But it takes repeat complaints, or patient death, for officials to look into physicians who may be overmedicating. 

While the country seems to be in a constant debate about what effects legalizing or decriminalizing marijuana may have on our youth, it seems that not enough people are paying attention to the effects legal narcotics are having on our elderly — or how often physicians are prescribing them. Proactive pro- and anti-pot research is conducted everywhere from to basements to universities. But it takes repeat complaints, or patient death, for officials to look into physicians who may be overmedicating. 

Understanding the Scope of the Problem

Since Medicare Part D began in 2006, it has become a popular program among senior citizens for helping to lower their drug costs. It currently covers about 38 million seniors and disabled people, and pays for more than one of every four prescriptions dispensed. As important as it is to get medication into the hands of those who need it, problem prescribers are being overlooked.

All mind-altering drugs are categorized according to Schedules I through V. Those in Schedule II are defined as having some medical use along with a high potential for abuse. They also require written prescriptions and cannot be refilled. ProPublica, a non-profit organization of investigative journalists, discovered that in 2012, nearly 27 million prescriptions for the powerful narcotic painkillers and stimulants classified in Schedule II were covered by Medicare. More troubling, 12 of Medicare’s top 20 prescribers of these drugs had previously faced disciplinary actions by their state medical boards or criminal charges related to their medical practices.

In 2012, 269 providers wrote at least 3,000 prescriptions for Schedule II drugs and about one in five of these doctors have faced some kind of disciplinary action. Florida had 52 providers that wrote at least 3,000 Schedule II prescriptions, followed by Tennessee with 25. North Carolina, Ohio, Georgia, Pennsylvania, Alabama and Kentucky each had more than 10. ProPublica has developed a Prescriber Checkup tool that includes controlled substance prescribing for each provider. You can look up your doctor here.

Why Not Be Proactive?

Tracking the prescribing habits of physicians and making sure the rules are followed has been largely left to state medical boards and law enforcement agencies. Most investigations are triggered by patient deaths or complaints from patients’ families, insurance companies or pharmacies rather than from Medicare using its own records to locate and flag fraud.

The records of prescribing data were not proactively analyzed and action against providers with troubling patterns was rarely taken. In fact, Medicare’s failure to follow up on unusual prescribing patterns and its elaborate, poorly managed process has allowed Medicare fraud to flourish.

The exposure of these flaws in the Medicare system has slowly begun bringing more openness to the medication choices of doctors nationwide.

Improvements On the Horizon

Medicare began to use prescribing data to identify potentially problematic doctors in 2013, and later this year it will have the authority to kick doctors out of the program if they prescribe in abusive ways.

Last month, the government released physician utilization data from the Centers for Medicare and Medicaid Services, covering $90 billion in payments across 950,000 providers. This is valuable information that may flag providers who should be asked questions because they prescribe certain drugs to a high proportion of their patients. Furthermore, some states have now made it mandatory that doctors check databases that track every controlled substance prescription in their state before prescribing such drugs to patients for the first time and at certain intervals afterward.

It’s time to take some steps to end prescription abuse underwritten by the government and hold healthcare professionals responsible for their actions.