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Senator Grassley Points to High Volume Prescribers as Likely Fraudsters

U.S. Senator Charles Grassley (R-Iowa), a long-time proponent of the False Claims Act and an anti-fraud advocate, has recently criticized reports of high-volume prescribers. In particular, Grassley addresses those prescribing extremely large quantities of mental health drugs. Recently, many pharmaceutical companies have agreed to large settlements involving the off-label promotion of these drugs, many of which are the must lucrative of the companies’ offerings.

In his report to Congress, Grassley identified a Miami doctor who allegedly wrote approximately 97,000 prescriptions in 18 months for mental health drugs- averaging about 177 prescriptions per day. He also cited a Texas doctor who wrote 14,170 prescriptions for Xanax in 2009.

As Medicare fraud is estimated to cost taxpayers between $60 to $90 billion a year, Grassley argues that “these programs can’t spare a dollar for prescription drugs that aren’t properly prescribed.” Grassley’s investigation sheds light on the concerning nature of high-volume prescribers and the relative ease with which they obtain reimbursement from Medicare and Medicaid.

In response to his investigation, Grassley sent a letter to the Department of Health and Human Services requesting an explanation as to how reimbursement claims are properly monitored and reviewed for billing aberrations.  While CMS did not immediately comment, federal officials have since terminated reimbursement to the Miami doctor cited in Grassley’s investigation. A Business Week article on Grassley’s letter can be found here.