Medicaid fraud is helping drive opioid crisis, new GOP congressional report suggests

WASHINGTON – A new congressional report suggests that Medicaid is helping drive the nation’s opioid crisis by making it easier for enrollees to abuse and then resell the highly addictive painkillers.

At least 1,072 people have been convicted or charged nationwide since 2010 for improperly using Medicaid to obtain prescription opioids, some of which were then resold on the nation’s streets, according to the report by Republicans on the Senate Homeland Security and Governmental Affairs Committee.

The number of criminal defendants increased 18 percent in the four years after Medicaid expanded under the Affordable Care Act, or Obamacare, the report said.

As of October, about 68 million people were enrolled in Medicaid.

“I’m not making the claim that this is just because of Medicaid expansion … this phenomenon happened way before Medicaid expansion,” Wisconsin Sen. Ron Johnson, the committee’s chairman, said during a hearing on Wednesday.

But, “this is an unintended consequence,” said Johnson, who opposed Medicaid expansion and for months has raised issues about the program and opioid addiction.

The committee's top Democrat, Claire McCaskill of Missouri, was ill with the flu and missed the hearing. But she took issue with the report. 

"This idea that Medicaid expansion is fueling the rise in opioid deaths is total hogwash," McCaskill said in prepared remarks. "It is not supported by the facts. And I am concerned that this committee is using taxpayer dollars to push out this misinformation to advance a political agenda."

Others — including backers of the Affordable Care Act — also questioned the report and said it was unfair to single out the Medicaid program since opioid overdoses are on the rise among people with all types of insurance. 

The Republican report highlights a number of ways that Medicaid recipients are abusing the program to obtain opioids. The criminal activities range from beneficiaries simply selling opioids they obtained through the Medicaid program to fraud involving Medicaid reimbursement.

More:Opioid epidemic 'getting worse instead of better,' public health officials warn

At Wednesday’s hearing, experts described, in often gruesome detail, the lengths to which patients often go to get the drugs.

In Tennessee, a couple took turns intentionally burning themselves on their lower legs with boiling water and then went to different emergency rooms to obtain pain medication paid for through TennCare, the state’s version of Medicaid, Tennessee Inspector General Emmanuel Tyndall said.

An office manager in a doctor’s office in Tennessee was charged with 87 counts of fraudulently obtaining the drugs after stealing prescriptions slips, forging the doctor’s signature, and then writing out prescriptions in her name and those of relatives. The woman admitted to using 25 hydrocodone pills per day, and some of the drugs were charged to TennCare, Tyndall said.

In Indiana, opioid abuse and the illegal selling of prescriptions is rampant among Medicaid beneficiaries, said Otto Schalk, the prosecuting attorney in Harrison County.

“I see day in and day out individuals that are Medicaid recipients dealing and abusing the prescription pills that are government funded,” Schalk testified. “It’s simply a fact. I see individuals getting arrested for selling their prescriptions, and yet they test clean for them when drug tested during the jail booking process.”

Doctor shopping, or acquiring prescriptions for the same type of controlled substances from multiple medical practitioners, also is widespread. A 2011 report by the Government Accountability Office found more than 170,000 Medicare beneficiaries receiving prescriptions for controlled substances from five or more medical practitioners.

Since Tennessee’s “doctor shopping” law became effective in 2007, the courts have ordered offenders to pay $292,000 to reimburse TennCare for such crimes, Tyndall said. Another $315,000 in restitution has been repaid to the program for drug diversion, including sale and forgery.

But while access to medical providers via Medicaid could make it easier to get addictive drugs, it’s unfair to single out the program, said Andrew Kolodny, an opioid researcher at Brandeis University.

More:Drug dealers increasingly charged with murder in overdose cases

Opioid overdoses have been increasing in people with all types of insurance and in people from all economic groups, Kolodny said.

Kolodny also questioned whether Medicaid expansion is making the opioid epidemic worse. Opioid prescribing has been trending downward slightly since 2012, he said.

The committee’s report suggested otherwise.

More than 80 percent of the 298 Medicaid-opioids cases identified in the study were filed in Medicaid expansion states, led by New York, Michigan, Louisiana, New Jersey and Ohio. The number of criminal cases increased 55 percent in the first four years after Medicaid expansion, the report said.

Other preliminary data in the report suggests a connection between Medicaid expansion and opioid abuse. Drug overdose deaths per one million people are rising nearly twice as fast in expansion states as non-expansion states, while opioid-related hospital stays paid for by Medicaid spiked after expansion, the report said.

More:Rutherford County DA joins four other prosecutors in lawsuit against opioid manufacturers

More:State collects record number of unused prescriptions in national drug drop-off day

Johnson called on the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to detail what the administration is doing to prevent Medicaid fraud tied to the obtaining and selling of opioids.

A group working to preserve Obamacare called the hearing “a farce” and blasted Johnson for connecting the opioid epidemic to Medicaid expansion.

“In American communities hit hard by the deadly opioid epidemic, Medicaid is a lifeline that connects those struggling with addiction with needed care,” said Brad Woodhouse of Protect Our Care.

Republicans are seeking to blame Medicaid “for the opioid crisis that was inflamed by Big Pharma,” Woodhouse said.

“As Republicans train their sights on Medicaid as the latest front in their war on our health care, Americans must reject insidious untruths like those being pushed at today’s hearing,” he said.