A recent government audit discovered that almost one in every seven elderly nursing home residents are given strong atypical antipsychotic drugs, without the consideration that these medicines raise the risk of death and are not approved for such treatments. Nearly all of these patients have dementia. The FDA has warned that these drugs, usually given to patients with serious conditions such as bipolar disorder or schizophrenia, are not appropriate for these patients.
This audit found that in the first part of 2007, the federal Medicare program paid for antipsychotics that were given in error during the first six months of 2007. This cost the program an astounding $116 million for that first half of that year.
Daniel Levinson, who is the inspector general of the Department of Health and Human Services, wrote that “government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions.” He also pointed out that these drugs such as Risperdal, Zyprexa, Seroquel, Abilify and Geodon, are “potentially lethal” to some elderly patients and that some drug manufacturers illegally marketed their medicines for these uses “putting profits before safety.”
The audit is a rare evaluation done by the government to check if doctors are treating Medicare patients as they should in nursing homes. Levinson recommended that the government should keep a record of the diagnoses given to Medicare patients so it can determine if the drugs prescribed to them are accurate and suitable for the patients’ needs.
Even though this is common in the private sector, an oversight such as this is extremely rare in the Medicare program and would most likely be strongly advised against by doctors’ groups and most in Congress who see government intrusions into the doctor-patient relationship as wrong.
In reaction to the audit, the Centers for Medicare and Medicaid Services said that some of the inaccurate use of antipsychotics in elderly nursing home patients is the consequence of drug manufacturers paying kickbacks to nursing homes to increase those prescriptions.
Medicare will most likely pay for the prostate cancer drug according to Medicare officials. The prostate drug, Provenge, extends one’s life for about four months and the cost is a whopping $93,000 per patient.
The Centers for Medicare and Medicaid claim that the bio-tech drug stood up to tests as being a “reasonable and necessary” medicine. This allows thousands of men to receive the drug through the federal government.
The agency will be taking comments for 90 days before it makes a final decision.
The premium that seniors pay for Medicare Part B will remain the same for next year as it was this year. This premium covers doctors visits and other things but not hospital stays.
This is the first time since 2000, and the sixth time ever, that the premium has not gone up from one year to the next.
Unfortunately, the unfaltering price is not an indication that health costs have stopped increasing, but the outcome of some strange accounting issues. Everything is explained in a fact sheet that the feds put out on September 19.
Premiums will be $96.40 a month for single people who make $85,000 or less and couples making $170,000 or less.
Sometime in 2009, costs are projected to go up. Premiums have been higher than normal compared to costs for the past few years, to help build up a contingency reserve that’s part of the program. Right now, the reserve in in good condition. After it was unintentionally withdrawn and used to cover hospice care that was supposed to be covered by another Medicare program, $9.3 billion was returned to the Part B account.
This news has been used by the AARP to keep the lobbying heat on Washington.
The front page of the New York TimesÂ (8/21, A1, Duhig) reads, “Medicare’s top officials said in 2006 that they had reduced the number of fradulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system. But according to a confidential draft of a federal inspector general’s report, those claims of success, which earned Medicare wide praise from lawmakers, were misleading.”
Administrators from Medicare “told outside auditors to ignore government policies that would have accurately measured fraud,” ending in a failure to “detect that more than one-third of spending for wheelchairs, oxygen supplies, and other medical equipment in its 2006 fiscal year was improper… That same year, Medicare officials told Congress that they had suceeded in driving down the cost of fraud in Medicare equipment to $700 million.” Because of these findings, “Congress might push for an investigation into the private company that was hired to fulfill Medicare’s auditing program.” according to Sen. Charles E. Grassley (R-Iowa).