TennCare blocks top drug prescribers

TennCare blocks top drug prescribers

April 18th, 2012 by Chris Carroll in News

Sen. Charles Grassley, R-Iowa, in this file photo. Grassley informed TennCare Director Darin Gordon in a Jan. 23 letter about possible Medicaid abuse in Tennessee.

Photo by Associated Press /Times Free Press.

Document: Letter from U.S. Sen. Charles Grassley

Letter from U.S. Sen. Charles Grassley.

Document: TennCare?s response to U.S. Sen. Grassley's letter

TennCare?s response to U.S. Sen. Grassley's letter.

Tennessee has blocked three medical professionals from billing the TennCare program after they prescribed excessive amounts of psychiatric drugs and addictive painkillers, officials said.

In a March 1 letter to U.S. Sen. Charles Grassley, R-Iowa, TennCare officials said they recently prohibited the prescribers from future billing after a review revealed high prescription rates for painkillers such as Oxycontin and Roxicodone.

Several other medical professionals in Tennessee are "under review" for high prescription rates, according to the March 1 letter, which the Chattanooga Times Free Press obtained Tuesday.

Late Tuesday, TennCare spokeswoman Alyssa Lewis said the medical professionals, all in Knoxville, are licensed physician's assistant Thomas Esser; Dr. Allen Foster, whose medical license was revoked after he pleaded guilty to health care fraud in U.S. District Court in 2011; and nurse practitioner Maimoune Wright, whose license was suspended in February for "unprofessional conduct," state records show.

The three prescribers could not be reached for comment Tuesday.

It was unclear Tuesday whether Esser, Foster and Wright are permanently banned from billing TennCare, the state's Medicaid program that provides care for poor, elderly and disabled Tennesseans.

The letter said the blocked trio, determined by the state to be "prescribing outside the standard of care," have been referred to the Tennessee Board of Medical Examiners. The board holds the power to administer disciplinary action up to medical license revocation.

The letter was a follow-up to Grassley, who has investigated nationwide prescription rates since 2010. The senator has said he wants to control Medicaid costs and determine whether doctors are gaming the system by writing too many prescriptions or milking a financial connection with drug companies.

"It wasn't like [Grassley] did this inquiry, therefore we found all this stuff," TennCare spokeswoman Kelly Gunderson said. "We have an ongoing process that identifies fraud and abuse and improper prescribing habits."

Based on TennCare data provided by the state, which documented Tennessee's top 10 prescribers of eight drugs, Grassley informed TennCare Director Darin Gordon in a Jan. 23 letter about "concerns about the oversight and enforcement of Medicaid abuse in your state."

In 2009, for instance, the top two Tennessee prescribers of Roxicodone, a painkiller, wrote more than one-third of the 5,612 prescriptions written by the state's top 10 prescribers, Grassley said. Those same two prescribers also were among the top four Oxycontin dispensers in 2010, state records show.

According to the March 1 letter, both prescribers are among the three blocked from billing the TennCare program. The letter does not specify which doctors prescribed which drugs.

But another Grassley example -- two Abilify prescribers who wrote nearly one-third of the 6,665 prescriptions penned by the state's top 10 prescribers -- are still able to bill TennCare, according to the state's letter.

Since most of the drugs included in Grassley's initial inquiry were psychiatric drugs, including Xanax and Abilify, psychiatrists often were listed as high-prescribing providers, which would not necessarily suggest wrongdoing given the needs of their patients, officials have said.

In his response to Grassley, Gordon did not say why the unidentified Abilify prescribers are still eligible to bill TennCare, but he offered a hint.

"We believe that other information, including but not limited to provider specialty, practice type and size and adherence to evidence-based treatment guidelines, is needed to accurately interpret this data," Gordon wrote.

Tennessee often ranks at the top of the list of states with the highest per-capita prescription drug use. Through a spokeswoman, Grassley said Tennessee's response "sounds productive."

"But it's hard to know whether the state has taken the right level of action," he said in a statement. "The state has blocked only a handful of prescribers from participation."