Medicare Charged with Paying for Pill Habits and Fake Patients

By Jennifer Matesa 10/06/11

Doctor-shopping, professional fake patients and elderly entrepreneurs may be aided and abetted by the social insurance program.

Not all patients are what they seem. Photo via

A new report scheduled to be heard by the Senate next week charges Medicare with underwriting the addictions of about 170,000 doctor-shopping beneficiaries who have bought scripts for addictive drugs on Medicare’s tab. Patients obtain the drugs through Medicare Part D, which pays for prescription medications. Drugs most commonly abused, the report says, are prescription painkillers including oxycodone and hydrocodone—AKA OxyContin and Percocet. Here's what doctor-shopping looks like: in one year, a Georgia Medicare beneficiary received prescriptions for more than 3,500 oxycodone tablets from 58 different physicians, filled at more than 40 pharmacies. A Texas man got more than 4,500 hydrocodone pills from 25 different doctors in a year, and a Medicare beneficiary in California received prescriptions for 1,397 fentanyl patches and pills from 21 different doctors. That’s a lot of drugs—more than one person could safely use, according to one of the doctors who prescribed for the Texas patient. Medicare officials have apparently hesitated to put limits on patients receiving drugs in such quantity—for example, by limiting patients to one physician and one pharmacy—because they want to protect patients’ access to care. However, there have been growing reports of elderly patients selling drugs to bring in extra income. And those who work in addiction treatment know that some people pose as patients to get drugs. “There are people who work as professional patients,” Neil Capretto, DO, medical director of Gateway Rehabilitation Center, Pittsburgh, told The Fix. “They go to multiple doctors every day, they get fake X-rays and scans—they’re real pros.”

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Jennifer Matesa is a Voice Award Fellow at the federal Substance Abuse and Mental Health Services Administration and is the author of the blog Guinevere Gets Sober. She is the author of several books, including the non-fiction, The Recovering Body, about physical and spiritual fitness for living clean and sober. You can find Jennifer on Linkedin or follow her on Twitter.