Sen. Carper blasts Medicare agency's response to his concerns on prescription-drug program integrity

Sen. Tom Carper (D-Del.) on Tuesday blasted the Medicare agency for what he considers an inadequate response to his concerns about the prescription-drug program's integrity.

"The Centers for Medicare and Medicaid response to my concerns about the $1.2 billion in Medicare prescription drug claims that contained invalid prescriber identifiers left a lot to be desired," Carper said in a statement.

Carper wrote to the Centers for Medicare and Medicaid Services on July 29 and requested the agency establish a process to ensure valid identification numbers on reimbursed prescriptions under the Part D program. The law requires the identification numbers to ensure drugs are being prescribed by legitimate health professionals, but an audit by the Health and Human Services Office of Inspector General found that $1.2 billion in reimbursements in 2007 — representing more than 18 million claims — contained invalid prescriber identification.

In its response to Carper, CMS points out that invalid identifiers don't automatically indicate an invalid prescription or a fraudulent claim. Some 98 percent of the errors the OIG found were related to a problem with invalid Drug Enforcement Agency numbers that has since been fixed, the agency added.

CMS said it would begin a prescriber identification project this month, while also allowing some prescriptions with wrong identifiers to go forward to avoid penalizing patients.

"Preserving beneficiary access to necessary prescription medications is at the heart of CMS’ mission for the Part D program," the agency wrote, "and the problem identified by the OIG, while serious, should be addressed by CMS in a manner that does not jeopardize the Agency’s mission to provide needed medical services and supports for our beneficiaries."

Carper was unimpressed.

"Instead of immediately addressing this problem," he said, "CMS is instead only reminding the Medicare prescription drug plans to follow the existing law and hiring yet another contractor to study the problem for a year. That just won't cut it."

Carper is a member of the Senate Finance Committee, which has jurisdiction over Medicare.