Stopping Medicaid Fraud & Prescription Drug Abuse in Ohio

Prescription drug abuse is an Ohio problem that we cannot afford to ignore.

In recent years, prescription drug overdoses have killed more Ohioans than car crashes. It’s likely that a teenager who lives on your block, a member of your community, or even a relative uses powerful painkillers – like Oxycontin – that have not been prescribed to them. The statistics are alarming and all of our communities are paying a high price.

Ohio’s death rate due to unintentional drug poisoning increased more than 350 percent from 1999 to 2008. In 2008, statistics show that oxycodone and other opioids caused more overdoses in Ohio that year than heroin and cocaine combined. And as Ohioans die or grow addicted to opioids, some unscrupulous people are cashing in on their addictions.

That is why I recently introduced the Stop Trafficking of Pills (STOP) Act to eliminate the Medicaid fraud that helps to finance prescription drug abuse.

Lax Medicaid restrictions make it easy for people to acquire prescriptions for drugs like oxycodone and morphine from multiple doctors and fill them at multiple pharmacies. People who commit Medicaid fraud then sell the extra medications to addicts – while taxpayers foot the bill.

In 2006 and 2007, the nonpartisan Government Accountability Office found about 65,000 cases in five states in which Medicaid beneficiaries visited six or more doctors and up to 46 different pharmacies to acquire prescriptions – a practice known as “doctor-shopping” that allows purchasers to exceed the legal limit of drugs.

We cannot afford to sit by while Ohio families pay the high costs – financial and personal – associated with the prescription drug abuse epidemic.

To eliminate the prescription drug abuse problem in our state, we must do a better job of cutting off the source. And that’s why my Medicaid Lock-In bill would address the fraudulent use of Medicaid cards to obtain and fill prescriptions for addictive pain medications.

The bill would require states to establish and implement a restricted recipient, or Lock-In program for high-risk prescription drug users. States would identify those individuals who would be considered high-risk users – for example, those who are receiving an excessive amount of prescription drugs or those who have been convicted of a drug-related offense – and identify prescription drugs that are dispensed under Medicaid that present a high risk of overutilization.

Medicaid Lock-In programs can be effective by limiting the doctors from whom a high-risk patient can receive prescriptions, as well as the pharmacies from which the patient can obtain prescription drugs for illicit use. This enables the kind of close monitoring needed to prevent high-risk patients from personally abusing or selling prescription drugs.

Only high-risk prescription drug users would be placed in the program and assigned to one physician and one pharmacy. The legislation also requires the Health and Human Services Secretary to set up a similar Lock-In program for Medicare.

We already have proof that Medicaid Lock-In programs can work.

South Carolina’s Medicaid Lock-In pilot program spurred a 40 percent decrease in the total number of prescriptions used and a 43 percent decrease in opiates. Several other states across the country – including our neighbors Indiana and Kentucky – have Medicaid Lock-In programs. Although currently states may voluntarily establish Lock-In programs, this bill would make them mandatory.

Ohio does not need to wait for the federal government to act. We can continue efforts to establish a Lock-In program in Ohio. Following meetings with community leaders throughout southern Ohio, I wrote to then-Governor Ted Strickland about establishing a Medicaid Lock-In program, which would enable the Office of Ohio Health Plans to better monitor and control access to prescription drugs that are subject to abuse and trafficking.

Almost exactly a year ago, I convened a first-of-its-kind roundtable in Ohio with federal and local law enforcement, community activists, and elected officials. We came together to discuss ways to eradicate the prescription drug abuse problem in our state. We can do this, together.

Let’s get back to what matters – supporting Ohioans who are working to improve our state and stopping the people who would take advantage of Ohioans who need Medicare and prescription drugs for medical reasons.

We cannot afford to wait.

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