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OIG Update – Data Brief on Excessive Use of Opioids in Medicare Part D

June 17, 2017

The Office of Inspector General’s (OIG) work plan has identified new areas of focus for the month of June. Recently added items include:

  1. Review of Quality Measures Data Reported by Accountable Care Organizations in the Medicare Shared Savings Program
  2. Data Brief: Excessive Use of Opioids in Medicare Part D
  3. Access to Buprenorphine-Waivered Providers for the Treatment of Opioid Use Disorder
  4. Including Non-covered Versions When Setting Payment Amounts for part B Drugs
  5. Follow-up: CMS’s Management of the Quality Payment Program
  6. Trends in Hospice Deficiencies and Complaints
  7. Medicare Drug Integrity Contractor’s Activities
  8. Invalid Prescriber Identifiers on Medicare Part D Drug Claims and 2016
  9. FDA—Approval Status of Drugs in the Medicaid Drug Rebate Program
  10. Accuracy of Drug Classification Data Used to Collect Medicaid Rebates
  11. Reasonable Assumptions in Manufacturer AMP Reporting
  12. Monitoring Children Enrolled in Medicaid and Diagnosed with Attention Deficit Hyperactivity Disorder
  13. CDC’s Global Health Security Agenda
  14. Review of the Food and Drug Administration’s Contract Closeout Actions
  15. HRSA’s Award Process for Zika Response and Preparedness Funds
  16. Case Study: Closure of the Rosebud Hospital Emergency Department
  17. HHS Resolution of Audit Recommendations
  18. NIH Compliance with Federal Requirements for Indirect Cost Rate Setting

Most of the updates will be published in 2018.

Of the 19 updates, 7 have to do with drug use, specifically directed at opioid use and you could stretch that to 8 if you include the inquiry and monitoring of children enrolled in Medicaid and diagnosed with attention deficit hyperactivity disorder.

For an extended explanation on item # 2 – Data Brief: Excessive Use of Opioids in Medicare Part D, it says: “Opioid abuse and overdose deaths are at epidemic levels in the United States. In 2015, the number of opioid-related deaths was higher than any previous year, exceeding 33,000 for the first time. Although opioids can be appropriate for some beneficiaries, OIG shares in concerns about opioid misuse, fraud, and abuse in Medicare Part D. Previous OIG work called attention to increased Part D spending for commonly abused opioids. OIG has also highlighted the problem of drug diversion—the redirection of prescription drugs for an illegal purpose, such as recreational use or resale. This data brief builds on OIG’s previous work and includes in-depth analysis of opioid utilization among Medicare Part D beneficiaries. It provides baseline data on the extent to which beneficiaries are receiving extreme amounts of opioids and appear to be doctor shopping. It also identifies prescribers who have questionable opioid prescribing patterns.”

Verisys Corporation has created a SaaS solution called ProviderCheck that accesses thousands of primary sources and instantly serves up a verified report of License status, NPI number, DEA detail and prescribing schedule.

Susen Sawatzki Written by Susen Sawatzki
Healthcare Industry Expert
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