Elderly nursing home patients have been routinely receiving costly antipsychotic drugs which increase their risk of death and are not approved for their treatment.
According to a report from the Health and Human Services Department’s inspector general, 88 percent of the antipsychotic drugs administered in nursing homes were prescribed for uses that the Food and Drug Administration hasn’t approved.
Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, the government audit found.
More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the study found, costing the program $116 million for those six months.
Sens. Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.) want Medicare to explain why it wrongly paid millions of dollars in claims for drugs that were given to seniors for these unapproved uses.
Medicare provides coverage for some unapproved uses, but the senators suggested that the report’s findings might indicate a flawed decision-making system.
The Medicare agency said in its response to the inspector general’s report that it should have denied more than half the claims it paid for the use of antipsychotics in nursing homes.
The inspector general of the Department of Health and Human Services went so far as to state that “government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions.”
According to the audit, some of the drugs such as Risperdal, Zyprexa, Seroquel, Abilify and Geodon are potentially lethal to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for these uses.
In response to the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions for the medicines.
Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions.
The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007, 304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5 million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months.
Federal rules require that any drugs that are paid for by the government be given only for uses that are approved either by the government or one of three independent drug usage encyclopedias. Auditors found that 51 percent, or 726,000 of 1.4 million claims, for antipsychotic medicines did not meet this criterion and were thus paid for by the government improperly.