ILLS NOT THAT HARD TO FIX

A small group of Florida's physicians are bilking Medicaid for
millions of dollars. Some pharmacists and patients as well are lining
their pockets because of lax oversight of drug prescriptions paid for
by Medicaid. The abuse of the system also contributes to the
burgeoning black market of prescription drugs and results in fatal
drug overdoses by people seeking a quick high or fast relief from
powerful medications.

In the meantime, state lawmakers continue to scramble to find ways to
cut Medicaid's costs and core health services while criminals reap
benefits and wreak havoc in the Medicaid system.

It's no secret that Medicaid fraud costs Florida dearly.
Unfortunately, the most disturbing part of the eight-month
investigation by the South Florida Sun-Sentinel into the problems
facing the state's health program for the poor is the missed
opportunities by government officials to curb criminal activity and
the horrendous abuses of the program.

Where's the rationale that allows a Medicaid patient to take home
8,500 pills of OxyContin? What excuse does the state Agency for Health
Care Administration have to explain why it paid out $4,490 for
painkillers prescribed by a physician who had been dead for the past
eight years? What's the rationale behind allowing physicians who have
had their medical licenses suspended, or have had numerous patients
die from drug overdoses, to continue dispensing powerful narcotics to
Medicaid patients?

According to the Sun-Sentinel investigation, less than 3 percent of
Florida's medical professionals issued the majority of the problematic
prescriptions. The newspaper found that 16 doctors each ordered more
than $1 million worth of prescription drugs.

Where's the government oversight?

Florida's health and law enforcement officials must take Medicaid
fraud and abuse more seriously than ever. It's unsettling to see
examples in the Sun-Sentinel series that illustrate how poorly some of
the recent state efforts have been in addressing an enduring and
expensive problem.

In 1999, for example, the Legislature established the Prescribing
Pattern Review Panel as a watchdog to check the spiraling costs of
pharmacy bills. This dog hasn't had much bark, much less a big enough
bite to make any real difference in curbing abuses.

The Agency for Health Care Administration hasn't had much success
confronting Medicaid fraud, either. According to the agency's own
data, up to 15 percent of the pharmacy claims AHCA receives "do not
correctly identify the prescribing physician."

That's unacceptable.

Putting aside AHCA's initial public-relations offensive in which the
agency criticized the Sun-Sentinel series to state lawmakers after
publication, it's encouraging to see that the agency now is seeking
reforms. Dr. Rhonda Medows, who heads AHCA, wants state lawmakers to
enact new sanctions against doctors and pharmacists who routinely
submit drug claims with erroneous information.

Give Florida Attorney General Charlie Crist credit for aggressively
pursing reform. His office is drafting legislation that would require
doctors to be approved by Medicaid before they can prescribe drugs to
the poor. That would close a glaring loophole that allows doctors who
are not in the program to continue writing prescriptions for
low-income patients and sending the bills to Medicaid.

The change would help authorities treat Medicaid fraud as a serious
and debilitating crime.

The fixes aren't all that difficult, if the Legislature can muster the
political will to pursue them.