PLAN TO EASE DRUG RULES STIRS FEAR

Prescription Fraud Will Rise, Some Say

MURPHY -- A General Assembly plan to loosen limits on Medicaid
prescriptions worries Western North Carolina officials who fear it
will worsen existing problems with drug fraud. "The Medicaid program
needs changes, but this one is not one of them and will not help our
clients' health and safety or help us spend our citizens' tax dollars
wisely," Lisa Davis, director of the Cherokee County Department of
Social Services, said this week. Legislators working on a final state
budget are considering proposals to raise the number of prescriptions
a Medicaid patient could get filled each month. Existing law limits
them to six a month unless a doctor overrides the cap. One plan would
raise that limit to eight; another would allow an unlimited number of
generic-drug prescriptions. Proponents say the current cap is too
restrictive because of the number of ailments treated with multiple
drugs.

Lawmakers are working with the Department of Health and Human Services
to set the new rule, which would go into place when the budget is approved.

Change likely Prescription drug companies are involved in the
legislative discussions and a change in the rule is considered very
likely. But in Cherokee County, Davis and others say such a change
would make it even harder to crack down on Medicaid patients who
"doctor shop," visiting multiple doctors for overlapping prescriptions
for popular painkillers such as OxyContin and methadone, then resell
the drugs.

Any increase in the number of prescriptions Medicaid patients may
obtain without scrutiny invites continued problems, Davis said. She
and her colleagues at DSS already blame prescription drug fraud in
part for her county's exploding Medicaid budget. Medicines cost the
county $5.3 million, or 22 percent of its Medicaid budget, in
1999-2000. By 2003-2004, that figure nearly doubled to $10.4 million,
or 31 percent of the budget.

Last budget year, it was up again -- to $12.2 million. Also, two
prescription painkillers -- the narcotic OxyContin and methadone, a
cheaper generic drug best known for its use in people suffering from
opiate withdrawal symptoms -- have contributed to much of the drug
problem in the state's western mountains since the late 1990s.
Cherokee County Sheriff Keith Lovin blames the prevalence of
prescription painkillers for more than a dozen overdose deaths in his
county since he took office in late 2002. Dealers and drug users cheat
the system by doctor shopping and filling prescriptions at different
pharmacies, Lovin and other law enforcement officers say. They might
use Medicaid to obtain one prescription at a government-subsidized
cost and pay cash for a second OxyContin prescription. "You keep one,
you sell one," said Tom Frye, a retired State Bureau of Investigation
agent who commands a multi-agency drug task force from Cherokee and
Clay counties. Records seized This week, FBI agents seized records at
two medical clinics and two pharmacies in the western communities of
Swannanoa and Franklin. Rick Schwein, the resident agent in charge of
the FBI's Asheville office, said the searches were part of an ongoing
criminal investigation, but declined to describe the probe. Lovin and
Frye say they think they could do a better job fighting prescription
drugs if they were allowed to find out who gets multiple prescriptions
filled and who doctor shops. Under state law, only the SBI and the
federal Drug Enforcement Administration have access to prescription
records for the purpose of enforcing controlled substances, said
Noelle Talley, spokeswoman for the state Department of Justice. Local
requests for prescription records go through the SBI, which typically
offers to open a case and work with local investigators on it, Talley
said. But Frye said requests to check out individuals frequently meet
with significant delays. "They're good to work with, but the SBI's
diversion unit -- the unit that deals with prescription drug fraud --
only has about 13 agents and I believe is based out of Greensboro,
which is a long way from here," Lovin said. Talley said any change to
existing law would have to go through the legislature. Meanwhile, HHS
spokeswoman Debbie Crane said this week that a recently created
Medicaid fraud unit in the department will scrutinize the prescription
patterns of doctors and dentists, looking for people who prescribe
unnecessary medication.