Medicare Flags Antipsychotic Drugs Erroneously Used in Nursing Homes
A recent audit by Medicare found that in the first half of 2007 nearly one in seven elderly nursing home residents were given atypical antipsychotic drugs which increase their risks of fatal side effects. Nearly all of the patients suffered from dementia; however, the drugs used were not approved for such treatment.
“This error wound up costing Medicare about $116 million over a six month period,” notes Alan Weinstock, an insurance broker at MedicareSupplementPlans.com.“People should find this very upsetting.”
Potentially Lethal Pharmaceuticals
The drugs involved include antipsychotic medications. These are considered “potentially lethal” to dementia patients. Some experts felt that the manufacturers “illegally marketed their medicines” and put “profits before safety.” Each of these prescription drugs is approved for use to treat antipsychotic issues such as schizophrenia and symptoms of bipolar disorder.
What the Medicare auditors found was that 83% of antipsychotic prescriptions for seniors in nursing homes were for non-approved uses and 88% were for dementia patients, for whom the drugs could be lethal.
Medicare Audit Outside Normal Scope
Normally, Medicare wouldn’t conduct this type of assessment. This type of “basic oversight” would likely be opposed by doctors’ groups and considered an intrusion into the doctor-patient relationship. Medicare responded by indicating that some of the inappropriate use of antipsychotics is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions.
Medicare rules require that medications which the government pays for can only be used in a manner prescribed by the government or one of three independent drug usage encyclopedias. The audit found that 51% of claims for antipsychotic drugs did not meet this requirement and, therefore, were paid erroneously by the government.
Even though the Food and Drug Administration (FDA) has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices.
Increase in Antipsychotic Drugs to Nursing Home Patients in 2005
Interestingly enough, it seems this problem isn’t new to Medicare patients in nursing homes. In fact, according to a 2005 study, more than one of every four Medicare beneficiaries in nursing homes was receiving antipsychotics in 2000-2001. At that time this was the highest reported rate in nearly a decade. This increase also raised concerns about quality of care especially when the drugs were not prescribed in accordance with guidelines.
Recommendations to Medicare to Correct Problem
U.S. Health and Human Services Inspector General makes these suggestions:
1. Examine the efficacy of survey and certification processes to prevent unnecessary antipsychotic drug use in nursing homes;
2. Consider alternative methods to ensure compliance with federal standards regarding unnecessary drug use in nursing homes; and
3. Take action against erroneous payments found by auditors.
All who heard about the audit felt the results were alarming. However, there is confidence that the situation can be corrected.
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