What Medicaid Fraud Means for Opioid Abuse

shutterstock 557361892

shutterstock 557361892

A January congressional report suggests that Medicaid, the very insurance policy that is supposed to help millions of low-income Americans gain access to healthcare, is partially to blame for driving the nation’s opioid crisis out of control. Medicaid expansion had this unfortunate effect by making it easier for Medicaid enrollees to gain access to, abuse, and to sell addictive pharmaceuticals.

According to the Senate Homeland Security and Governmental Affairs Committee, since 2010 1,072 Americans were arrested, convicted, and charged with some crime having to do with using Medicaid to obtain prescription opioids for resale. In the four years following Medicaid’s expansion under the Affordable Care Act, criminal defendants caught for abusing Medicaid insurance increased by eighteen percent.

While Medicaid misuse has been an issue for much longer than the initiation of the Affordable Care Act, an unfortunate side effect of making Medicaid more available for low-income families is that the use of Medicaid for illegitimate reasons will also increase. Such criminal activities range from Medicaid enrollees simply abusing or selling the drugs they get through the program all the way up to enrollees committing fraud regarding Medicaid reimbursement. Ease of access to the insurance and fewer restrictions, guidelines, and checks and balances on the insured make Medicaid far easier to manipulate. This is a dire effect of an approach to health insurance that began with good intentions.

Illegitimate, fraudulent use of Medicaid has been the talk of the day in the state-funded insurance district since Medicaid was made more available to the public. Incidences in Tennessee cropped up several times over a short period. Patients were exposed for physically harming themselves in order to obtain pain meds covered by TennCare, Tennessee’s Medicaid. Similar cases were found and made public in Indiana, Ohio, and other states across the Union. Medicaid recipients in the above states were also caught selling Medicaid-funded pain drugs on the streets for a significant profit margin.

Medicaid and Doctor Shopping

A report by the Government Accountability Office reported that more than one-hundred and seventy-thousand Medicaid beneficiaries received prescriptions for controlled substances from five or more practitioners in just one year. This is called “doctor shopping” and it is a real problem in the U.S.

Doctor shopping has been on an increasing trend for some time now, with patients of all types of insurances and self-pay scenarios engaging in this illegitimate trend. In fact, doctor shopping got so bad in the mid-2000s that fifty percent of U.S. states instituted “Prescription Drug Monitoring Programs” or PDMPs. The goal behind PDMPs was to carefully and cautiously analyze all patients in all states who received prescriptions for potentially addictive drugs at various pharmacies. So monitored, doctors and pharmacists would be able to discern if any, one patient in front of them at any time was doctor shopping or not.

Controversy Over Medicaid

Some government officials argued that the changes in Medicaid have nothing to do with the increase in the opioid epidemic. However, more than eighty percent of all Medicaid crime is committed in states where Medicaid was expanded, e.g. New York, Michigan, Louisiana, New Jersey, Ohio, etc. The number of criminal cases regarding the fraudulent or abusive use of Medicaid increased fifty-five percent in the first four years following Medicaid expansion.

Another critical factor here is that overdose deaths on opioids are increasing at a rate two-hundred percent faster in Medicaid expansion states than they are in non-Medicaid expansion states. Yet another factor here is that hospital visits due to opioid overdoses that are then paid for by Medicaid have also increased in states where Medicaid was made more available to the citizenry.

The Real Culprits

Medicaid expansion may have contributed to the current opioid epidemic, but it certainly did not cause the epidemic. In fact, Medicaid contribution arrived late to a vicious party of massive increases in opioid abuse nationwide that had been ongoing for some years. The real culprit here is Americans’ incessant reliance on opioid pain relievers to treat even the most minor of pain problems. When this is coupled with Big Pharma’s money-motivated and power-hungry greed to meet that desire, it makes for a melting pot of vicious addiction crisis.

The U.S. got itself into a vicious trap in the late 1990s when doctors began to prescribe more opioid pharmaceuticals to help patients who struggled with pain. Little was known about the pain drugs at the time, but now it is evident that they are more harm than they are a benefit.

To resolve the American addiction crisis, it will take far greater effort than simply changing Medicaid policy. We need to completely revolutionize the way pain management and pain resolution is performed in the U.S. The United States needs to focus on pain approaches that do not involve highly addictive and potentially lethal opioid prescription pain relievers.





1 Comment

  1. Avatar Marin Pearson says:

    I believe the culprits are not necessarily the abusers, the the doctors that prescribe these addictive drugs. And not only addictive drugs, but many other types of drugs as well. When it comes to dealing in drugs, doctors should be held accountable as any drug pushers on the street would be
    if any fraud or criminal type behaviour is suspect. We need more policing and random follow up where at minimum, opioids are prescribed. Also there should be large penalties for doctors receiving benefits or gifts from big pharmaceuticals for selling their products. Doctors are the dealers, and should be treated and respected as such by law enforcement.
    I for one, have not been to see a doctor for twelve years. I will suffer through any pains or sicknesses on my own. I have no confidence in doctors whatsoever after my wife committed suicide after being on Effexor for a short time. I personally knew her better than any doctor and she did NOT need to be put on antidepressants. It appears that many doctors are so quick to push drugs across the counter to make a quick dollar and quickly get to the next patient.
    Our drug perscription system is dead and needs a shock treatment to revive it and bring it back to a living, responsible system.
    Unless that happens, we are just digging ourselves deeper into an endless grave of corruption, abuse and overdose.

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