CMS proposes to ban problem prescribers

Tools

On the heels of a warning from the Office of Inspector General to do more to stop problem prescribers, the Centers for Medicare & Medicaid Services has proposed a series of unprecedented actions.

In particular, CMS' proposed rule would for the first time give the agency the authority to kick abusive prescribers out of the government program, ProPublica reported. CMS could also ban physicians and other providers whose licenses have been suspended or revoked by state regulators or given similar drug-related sanctions.

These changes mark a dramatic shift for CMS, ProPublica noted, as the agency, "historically has given much higher priority to making medications easily accessible to seniors and the disabled than to weeding out dangerous providers."

Nonetheless, the proposed rule will also require providers to formally enroll in Medicare before writing prescriptions under the Part D drug program, a change that will require these clinicians to verify their credentials and disclose professional discipline and criminal history.

"Currently, Medicare and the private insurers that run Part D know little about those writing the prescriptions--even those whose yearly tallies cost millions of dollars or who prescribe high volumes of inappropriate drugs," ProPublica noted. "ProPublica found that some of the doctors had been criminally charged or convicted, had lost medical licenses or had been terminated from state Medicaid programs serving the poor."

The rule is scheduled to be published on January 10 and will be open for public comments until March 7. The new rules would go into effect January 1, 2015.

To learn more:
- read the article from ProPublica
- here's the proposed rule

Related Articles:
CMS drafts new Medicare integrity regulations
OIG to CMS: Watch for problem prescribers
Surprising facts about pharma's best paid pill-pushing docs
New online tool tracks doc prescribing habits