Posted on Sun, Oct. 21, 2007

Prescription tracker could raise red flag

Taxpayers fund illegal drugs — and treatment

By Mary Meehan

mmeehan1@herald-leader.com

While in drug court, Dawn Nicole Smith says, she used her state Medicaid card to pay for painkillers. So, essentially, taxpayers were paying for her treatment for addiction and for her drugs.

Common sense might dictate that there should be a way to prohibit that, especially with KASPER, Kentucky's often-praised electronic system for tracking prescription narcotics.

But when dealing with multiple agencies, various computer systems and basic human nature, it's not so simple.

Kentucky's 9-year-old system is considered one of the best in the country, said Doug Robinson, executive director of the National Association of State Chief Information Officers. But, he said, getting computer systems to work together is extremely complicated. It's not so much a technology problem, he said, as making sure all involved agencies use the same terminology. And there are often regulatory and jurisdictional conflicts to sort through.

In Dawn's case, she says she found a doctor known for a free hand at writing prescriptions to obtain the drug Ultram and, sometimes, the painkiller Lortab using her Medicaid card. She had a serious hip injury as a child and sometimes used that to help obtain drugs.

Because she was passing her drug tests, Dawn's caseworkers and judges didn't run a KASPER report. There didn't appear to be a need to.

But many judges, drug court workers, and probation and parole officers are not aware that they can easily obtain a KASPER report online, said Zach Ramsey, director of the Division of Fraud, Waste and Abuse/Identification and Prevention in the Office of the Inspector General at the Kentucky Cabinet for Health and Family Services.

During the past year, Ramsey's office has concentrated on getting the word out that they have a right to access the system if they suspect someone under their watch is abusing prescription drugs.

KASPER is also testing a new way to review Medicaid prescriptions. Until recently, Medicaid claims were not routinely reviewed as a batch in KASPER. But now KASPER will produce a regular report on Medicaid clients who appear to be overusing their prescription-drug benefit for narcotics. Historically, he said, Medicaid is not widely used to obtain drugs for abuse.

Technically, he said, a KASPER program could be created that would raise a flag when a prescription for a scheduled drug such as Lortab or Xanax is given to a person who is under court order not to use drugs.

But Ramsey said that creating such a system would depend on the political will to further expand KASPER's uses, and that is iffy, especially considering the highly personal nature of medical information.