Yesterday, as part of its continuing “data transparency initiative,” CMS released detailed data on over a billion prescriptions dispensed to Medicare beneficiaries in 2013 under the Medicare Part D Prescription Drug Program. That information is now publicly available on CMS’ website, here. According to CMS, the transparency “will give patients, researchers, and providers access to information that will help shape the future of our nation’s health for the better.” The newly-released data lists every prescriber, the type of drugs dispensed, the total number of prescriptions and total drug costs, along with other related information. This data release follows the unprecedented release of payment data in April 2014, and the launch of CMS’ open payments website in September 2014.
Yesterday’s data release has already garnered substantial criticism. Both the Pharmaceutical Research and Manufacturers of America and the American Medical Association have called the information misleading, lacking context, and an inaccurate representation of actual Part D spending. One of the criticisms is that some physicians who appear to be outliers in prescribing branded medication may be treating patients for conditions where there is no general equivalent available.
As with any transparency initiative, yesterday’s data release will likely lead to an increase in government investigations and whistleblower filings related to Medicare Part D prescription patterns. For example, a potential whistleblower can now search the Open Payments website to find out whether a prescribing physician received payments or anything else of value from a pharmaceutical company, and then compare that information against the Part D database to determine what types of drugs that physician prescribed. Such information could help a potential whistleblower assemble a False Claims Act suit premised upon a violation of the Anti-Kickback Statute.
All physicians who treat Medicare beneficiaries should check all of the available CMS databases to ensure that all of the information pertinent to them is correct. If inaccuracies are uncovered, or any other concerns arise, we encourage you to contact us immediately to discuss available options.