The Department of Health and Human Services is trying to prevent people from using Medicare prescription drug plans to do “doctor shopping” for pain medication. This is part of the federal government’s efforts to combat fraud within the Medicare system.
The term “doctor shopping” does not mean that someone is calling up different doctor’s offices on the phone, in an attempt to learn what they would be charged by that office for a standard visit. It doesn’t mean that someone is trying to discover which offices accept the person’s health insurance plan.
Instead, “doctor shopping” is a term that refers to a type of fraud. It is a phrase used to describe the actions of a person who is trying to obtain more prescription pain medication than he or she has been prescribed by their doctor. Typically, this is done by a person who has developed an addiction to that particular painkiller, and who is going through their original prescription at a faster rate than is safe, or healthy.
Usually, a doctor prescribes a medication, and the patient goes to their local pharmacy to have the prescription filled. The person takes the recommended dosage of the medication. If the doctor feels that the person requires another dose, then the doctor will prescribe it. If not, then the doctor will not allow that prescription to be refilled.
Those who engage in “doctor shopping” start by getting a prescription for a painkiller medication from their doctor. Next, they visit several other doctors. The person doesn’t mention that he or she already has received a prescription for that drug.
The second doctor, unaware that the person already has been prescribed this medication, writes out a new prescription. Some people will go from doctor to doctor in an attempt to obtain as large a quantity of a particular painkiller as possible.
The Department of Health and Human Services has noticed that “doctor shopping” has been occurring with some of the people who are using Medicare. This is happening with painkillers, such as OxyContin and Percocet. The Department of Health and Human Services wants doctors that prescribe these types of medications to limit the supply to 30 days or less.
According to the Government Accountability Office, in 2008, there were around 170,000 people in Medicare who received prescriptions from five or more doctors for the types of drugs that are the most frequently abused. This resulted in around $148 million in prescription drug costs. The federal government has been cracking down on Medicare fraud, and has recovered nearly $3 billion this year through its efforts.
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