Massive Medicaid Fraud Alleged In Drugging Of Kids

The Law Project for Psychiatric Rights (known as Psych Rights) yesterday sent letters to several members of Congress, including Sen. Charles Grassley (R-Iowa), alleging that since the 1990s Medicaid has been paying for psych meds used in kids off-label and without inclusion in any pharmacopeia and that such actions violate federal law. There is federal law specifically instructing Medicaid to not pay for such drugs unless they are FDA-approved for a specific indication in a specific population.

If there's not some kind of exemption involved here allowing Medicaid to do this and if Psych Rights' claim is correct, then Medicaid is paying for at least $2 billion a year and possibly much more in medications it should not be paying for. That's kind of a massive problem, which I hope gets sorted out in short order.

Here's the meat of Psych Rights' letters, which you can view for yourself at the group's website:

"With respect to the second generation neuroleptics, no pediatric use of Seroquel, Zyprexa or Geodon is approved by the FDA or supported by any of the designated compendia. Risperdal is approved for very narrow uses, as is Abilify, but even when prescribed for these indications, they are almost always prescribed concurrently with another drug(s), which is not FDA approved or supported by any of the designated compendia. In 2007, through a state Freedom of Information Act Request, PsychRights was able to find out that Medicaid was paying approximately $123,000 per month for anticonvulsants prescribed to children and youth and $288,000 per month on second generation neuroleptics for a total averaging approximately $411,000 per month in improper Medicaid payments in Alaska alone. Extrapolating this to the entire country, there is over $2 Billion in Medicaid payments for psychiatric drugs to children and youth that Congress has explicitly prohibited. In truth, this is the smallest amount because typically two or more of these drugs are administered concurrently, in what is called poly-pharmacy, none of which has been approved by the FDA for pediatric use or supported by any of the designated compendia."

It will be interesting to see where this all goes.