Massage therapists, athletic trainers, interpreters and others who aren’t allowed to write prescriptions apparently issued at least 417,000 under Medicare. 
 
 A massage therapist works on the shoulder of a patient in Lakewood, Colo. Massage therapists, athletic trainers, interpreters and others who aren't allowed to write prescriptions apparently issued at least 417,000 under Medicare. (John Moore/Getty Images) 
 
 The study released today by the inspector general of the U.S. Department of Health and Human Services, identified more than 417,000 such prescriptions paid for by Medicare’s prescription drug program in 2009. The tally included initial prescriptions and refills dispensed by pharmacies. 
 
 Hundreds of thousands of times each year, Medicare pays for prescriptions purportedly written by massage therapists, athletic trainers, interpreters and others who aren’t allowed to prescribe drugs, according to a new federal report. 
 
 The inspector general found nearly 30,000 prescriptions for painkillers and other easily abused drugs that appeared to be prescribed by individuals who had no authority to do so. Such prescribing could “endanger patients” and “may also contribute to the prescription drug abuse problem in our nation,” the report said. 
 
 The cost of all the questionably prescribed drugs came to $31.6 million, according to the study. Although just a small fraction of total drug spending in the program, known as Part D, it raises questions about how closely Medicare tracks the validity of prescriptions or investigates those that appear suspicious. 
 
 “In a prescription drug program like Part D, $31 or $32 million may not sound like a lot, but every little bit adds up,” said Sen. Tom Carper, D-Del., chairman of the Senate Homeland Security and Governmental Affairs. “We don’t have the money in Medicare to be wasting for this area.” 
 
 Carper’s panel has scheduled a hearing this afternoon on prescription abuses in the program, which cost the government $62 billion last year. 
 
 The report is the second in days in which the inspector general faulted Medicare for its lax oversight of the program. On Thursday, the IG said it had identified more than 700 doctors with highly questionable and potentially dangerous prescribing patterns and called on Medicare to do more to investigate them. 
 
 It was not clear from the new report whether the drugs were actually prescribed by the massage therapists and others or if a pharmacy had mistakenly attributed drugs to them that were legitimately prescribed by others. Another possible explanation is that the prescriptions were fraudulent. 
 
 The inspector general identified prescribers and their specialties using a federal database that includes unique identification numbers, addresses and practice information reported by providers, including their primary specialties. 
 
 Analysts tried to exclude those who may have had authority to prescribe drugs despite appearances. For example, someone who identified himself or herself primarily as a dietician also may be a licensed physician. 
 
 In its response to the study, the Centers for Medicare and Medicaid Services (CMS) said some of the examples cited by the report may be due to weaknesses in the federal database relied upon by the inspector general. CMS said it is working to shore up the database, but noted it relies on health professionals to keep their information up-to-date. 
 
 Even so, the agency said it would ask its fraud contractor to examine the issue and it would investigate the examples found by the inspector general. 
 
 “We have already launched several efforts to address these vulnerabilities, such as an intervention program in an area of high drug abuse and better data analyses to detect patterns of fraud and abuse,” an agency spokesman said in an email to ProPublica. “We agree with the OIG recommendations and are evaluating next steps to continue improving our oversight of Part D.” 
 
 The inspector general’s office said its analysts did not contact providers to ask if they had actually prescribed the drugs. 
 
 The report highlights, but doesn’t name, a Florida dietician as having ordered about 2,600 prescriptions for 165 patients. 
 
 ProPublica used Medicare data it had previously obtained to identify a Florida dietician with a similar tally in 2009, the same year studied by the inspector general. Rocio Garcia, a dietician at Jackson Memorial Hospital in Miami, said she’s never prescribed a drug: “I can’t. I’m not a doctor.” 
 
 “I don’t know what to make of this,” Garcia said. “How could they link my name to [the prescriptions] if I’m not a doctor?” 
 
 To make sure that payments are accurate, the inspector general said Medicare should require the private insurers that administer Part D to verify that a provider has authority to prescribe drugs before paying for them. 
 
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 More than 700 doctors nationwide wrote prescriptions for elderly and disabled patients in highly questionable and potentially harmful ways, according to a critical report of Medicare's drug program released today. 
 
 The review by the inspector general of the U.S. Department of Health and Human Services flags those doctors as "very extreme" in their prescribing – and says that Medicare should do more to investigate or stop them. 
 
 The study mirrors a ProPublica investigation last month that found Medicare had failed to protect patients from doctors and other health professionals who prescribed large quantities of potentially harmful, disorienting or addictive drugs. 
 
 Medicare's prescription drug program was launched in 2006 and now accounts for about one of every four drugs dispensed nationwide. Last year, the government spent $62 billion subsidizing the drugs of 32 million people. 
 
 "Strong oversight of the Medicare prescription drug program is critical for protecting patients from harm," Sen. Tom Carper, D-Del., said in an email. 
 
 Carper chairs the Senate Homeland Security and Governmental Affairs Committee, which has scheduled a hearing Monday about prescription abuse in the Medicare program, known as Part D. 
 
 The inspector general's report focused on the prescribing of nearly 87,000 general-care physicians, such as family practitioners and internists, in urban and suburban areas in 2009. These doctors accounted for about half of all the prescribing in the program that year. 
 
 The review found more than 2,200 doctors whose records stood out in one of several areas: prescriptions per patient, brand name drugs, painkillers and other addictive drugs or the number of pharmacies that dispensed their orders. 
 
 Of those, 736 were flagged as "extreme outliers." Their patterns, the report says, raised questions about whether the prescriptions were "legitimate or necessary." 
 
 For instance, 24 doctors wrote more than 400 prescriptions for at least one patient, including refills dispensed. One Ohio physician did so more than a dozen times, according to the report. The average doctor wrote 13 per patient. 
 
 In another case, an Illinois doctor had prescriptions filled by 872 pharmacies in 47 states and Guam. General-care doctors, on average, had prescriptions for all their Medicare patients filled by 52 pharmacies. 
 
 The cost to the government was enormous in some instances. Medicare paid $9.7 million for the prescriptions of one California doctor alone – that is 151 times more than the cost of an average doctor's tally, the report says. 
 
 Most of this physician's drugs were supplied by just two pharmacies, both of which had previously been identified by the inspector general as having questionable billing practices. 
 
 All told, the drugs ordered by the doctors labeled "extreme outliers" cost Medicare $352 million, the report says. 
 
 While some of this may have been appropriate, the report says, "prescribing high amounts on any of these measures may indicate that a physician is prescribing drugs which are not medically necessary or that he or she has an inappropriate incentive, such as a kickback, to order certain drugs." 
 
 Sen. Tom Coburn of Oklahoma, the ranking Republican on Carper's committee, said no one wants Medicare to tell doctors which drugs to prescribe. But the government does have a responsibility in preventing fraud and abuse, he said. 
 
 Medicare officials "should be using their data to make sure those practicing medicine are practicing medicine and not practicing a sham," said Coburn, who is also an obstetrician. 
 
 The inspector general's report calls on the Centers for Medicare and Medicaid Services (CMS), which oversees the program, to step up scrutiny of doctors with questionable prescribing patterns. It urged CMS to direct its fraud contractor to expand its analysis of prescribers and train the private insurers that administer Part D on how to spot problem prescribers. 
 
 Medicare also should send doctors report cards comparing their prescribing to their peers, the report says. 
 
 In a response to the inspector general, the Medicare agency wrote that it agreed with the recommendations, has been working to reduce overuse of narcotics and plans to expand its use of data to flag questionable prescribing. 
 
 "We must balance these efforts with ensuring that beneficiaries have access to the medicines they need," a CMS spokesman said Wednesday in a statement. 
 
 For ProPublica's investigation, reporters analyzed four years of Medicare prescription drug data and examined the prescriptions of all health professionals across specialties. It examined all prescribers – 1.7 million in 2010 alone – not just those in general-care specialties or mostly urban areas. 
 
 The new report from the inspector general is the latest to find oversight problems in Part D. Previous reports found that insurers have paid for prescriptions from doctors who were barred by Medicare or whose identities were unknown to insurers or Medicare. 
 
 Coburn said Medicare has had repeated warnings that it was failing to properly oversee the program. 
 
 "This is incompetency and lack of somebody being held accountable," he said. "It's fixable."
– Massage therapists and home contractors are not authorized to prescribe drugs—but Medicare will still cover the cost, anyway. That's according to a new study by the Department of Health and Human Services, which found Medicare paid $31.6 million in 2009 as part of its Part D program for 30,000 prescriptions written by people who ... can't actually write prescriptions, ProPublica reports. People like nutritionists, opticians, art therapists, vets, and interpreters, it says in the report. Given many of the drugs prescribed, such as painkillers, are easily abused, the department's inspector general found the error isn't just dangerous, but "may also contribute to the prescription drug abuse problem in our nation." The news comes just days after the inspector general released another report identifying over 700 doctors in the US with " question able prescribing patterns," ProPublica reports. In one case, a doctor had prescriptions filled in 872 different pharmacies in 47 states and Guam. In another, Medicare paid $9.7 million in one year for the scripts of a single doctor—151 times the average.