New GAO Report Commissioned by Sens. Toomey & Kaine Says Seniors at Opioid Abuse Risk, Medicare Oversight Improvements Needed

Washington, D.C.—Senators Pat Toomey (R-Pa.) and Tim Kaine (D-Va.) issued the following statements on a new report by the Government Accountability Office (GAO) that shows more than 700,000 Medicare beneficiaries who receive high doses of opioid painkillers are at risk of abuse due to significant operational gaps within the federal health insurance program.

“This report is a stark reminder that much more still needs to be done to prevent overutilization, diversion, and abuse of prescription opioids in the Medicare program,” said Senator Toomey. “The Centers for Medicare and Medicaid Services should urgently adopt GAO’s recommendations to better protect the health of opioid-using seniors and stop fraudulent prescribing.”

“Senator Toomey and I asked for this study by the GAO because we wanted to see how to improve the way Centers for Medicare and Medicaid Services (CMS) tracks opioid overprescribing that's been contributing to this national crisis. This report’s findings are troubling and show that more needs to be done to protect seniors from the dangers of opioid overuse,” said Senator Kaine. “We have to improve CMS’s efforts to oversee opioid prescribing practices by doctors and ensure seniors aren’t receiving prescriptions that go well-beyond the amount their health conditions require.”

The GAO report, jointly requested by the Senators, found several improvements are needed to the current strategies used by the Centers for Medicare and Medicaid Services (CMS) to track which patients are overprescribed opioids. In particular, GAO detailed concerns about CMS’s overutilization monitoring system, which currently provides an additional level of scrutiny for just 33,223 opioid-using beneficiaries, a mere fraction of the 727,016 individuals who GAO believes are at risk of harm due to the high doses of prescription opioids they received over a six-month period.

GAO also concluded that “CMS’s efforts to oversee opioid prescribing [by individual providers] are also inadequate,” and recommended expanded oversight efforts and information sharing between anti-fraud contractors and Part D insurers to ensure appropriate action is being taken to reduce harm to beneficiaries and safeguard against fraudulent prescribing.

Read the GAO’s report and recommendations: Prescription Opioids: Medicare Needs to Expand Oversight Efforts to Reduce the Risk of Harm

BACKGROUND:

• Related report by the Department Health and Human Services Office of the Inspector General: Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing

• Recent efforts by the Centers for Medicare and Medicaid Services to fight opioid abuse: Opioid Misuse Strategy 2016

• Information about the Stopping Medication Abuse and Protecting Seniors Act: Senate Passes Bipartisan Measure to Fight Heroin and Opioid Epidemic

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