GAO Uncovers Medicaid Prescription Drug Fraud

According to a new report from the Government Accountability Office (GAO), over 16,000 Medicaid beneficiaries may have engaged in ‘doctor shopping,’ or visiting five or more physicians for prescriptions for antipsychotics or respiratory medications amounting to $33 million. Furthermore, 700 beneficiaries received more than a one-year supply of the same drug at a cost of $1.6 million to the Medicaid program. The GAO reports that this is an indicator of diversion, or the redirection of prescription medication for illegitimate purposes. The report draws on data from Arizona, Florida, Michigan, and New Jersey from 2011, the most-recent year for which reliable data is available. GAO recommends that the Centers for Medicare and Medicaid Services (CMS) consider lock-in programs for non-controlled substances, which would restrict beneficiaries who have abused the program to one health-care provider, one pharmacy, or both. GAO also suggests CMS look into the prohibition of automatic refills, which would reduce the potential for stockpiling.

Urban Institute Proposes ACA Changes

The Urban Institute has released a new paper recommending changes to address the affordability and access challenges that continue to face the Affordable Care Act (ACA). The proposed changes for the future include altering the premium tax credit schedule and tying subsidies to gold plans sold on the exchanges instead of silver plans in order to reduce the average cost-sharing requirements per household. The report also recommends a change to allow family members to use subsidies to purchase insurance in the marketplace if employer insurance coverage for the family, and not just the individual employee, is deemed unaffordable. Additionally, the researchers suggest increasing federal grants for IT development and operations, consumer outreach and enrollment, and enforcement of regulations. The proposed changes would be paid for in part through increasing the Medicare payroll tax, the extension of Medicaid drug rebates to Medicare, and a cap on the tax exclusion for contributions to employer-based health insurance.

Uninsured Rates Across the Country Continue to Drop

There has been a statistically significant drop in the uninsured rate for most states since the 2010 health care law took effect at the beginning of 2014, according to the Gallup-Healthways Well-Being Index. Arkansas and Kentucky have seen the sharpest reductions in their uninsured rate, while Oregon, Rhode Island, and Washington all experienced at least a 10-percentage point reduction in their number of uninsured residents. Of the top 10 states with the greatest reductions in uninsured rates, seven expanded their Medicaid programs. Collectively, Gallup finds that the data indicates that uninsured rates in states who chose to expand Medicaid and set up their own health exchanges or form a state-federal partnership marketplace declined significantly more than the uninsured rates in states that did not chose to embrace these parts of the law.

Upcoming Congressional Meetings and Hearings

House Veterans’ Affairs Subcommittee on Health: field hearing titled “Realizing Quality Rural Care Through Appropriate Staffing and Improved Choice;” 10:00 a.m., National Guard Armory, 1170 East Portage Ave., Sault Ste. Marie, Mich.; September 1

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