A Texas health agency has begun investigating more than three dozen healthcare providers who prescribed large quantities of powerful psychiatric drugs -- some to children -- after a U.S. senator raised questions about the medications.
The Texas Health and Human Services Commission has referred three providers to the attorney general for criminal prosecution, state Health Commissioner Thomas Suehs wrote to Sen. Charles Grassley last month. Some have been excluded from the Texas Medicaid program, including one convicted in a criminal case and another accused of inappropriate billing and coding of hours related to patient services.
The state has referred another provider to the state's private Medicaid claims processor for "further recoupment." Two providers were referred to licensing boards for action. All of the providers were sent what the agency calls educational letters. The state didn't identify them.
In 2010, Grassley, R-Iowa, began investigating the use of addictive mental-health drugs that have the potential for fraud and abuse. In response to his inquiries, the state listed the top 10 prescribers of eight psychotropic and pain medications, although commission spokeswoman Stephanie Goodman said Texas already had psychotropic medications under review.
In a letter to Grassley last month, Suehs outlined what the state did to detect, though not necessarily curb, overprescribing.Suehs said that while a high prescription rate may be cause for concern, "the presence of this high rate may not necessarily be indicative of fraud or abuse on its own."
Most of Suehs' letter is in response to specific questions from Grassley. For example, Grassley asked whether the state has a system to identify and monitor excessive prescription-writing.
Suehs responded that investigations are not based on the volume of prescriptions: "Investigations arise from the receipt of a specific allegation of fraud, provider self reports and computer data matches."
He wrote that the inspector general verifies that each provider is in good standing before Medicaid enrollment.
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