New Initiatives Drive Workers’ Compensation Improvements
Helping workers who are injured or become ill on the job is a central tenet of our mission in the Office of Workers' Compensation Programs. In fiscal year 2019, we made significant improvements in our efforts to combat the opioid epidemic and to reduce medical fraud.
In September 2019, we implemented new opioid controls to further protect injured federal workers and reduce the risk of long-term opioid use. The new controls impose a seven-day limit on an initial opioid prescription fill. A worker can fill three subsequent seven-day opioid prescriptions for a maximum of 28 days but must get approval for any additional prescriptions.
The department’s latest data on injured federal workers shows:
- 40% decline in overall opioid use
- 26% drop in new opioid prescriptions
- 57% decline in new opioid prescriptions that last more than 30 days
- 49% decline in claimants prescribed a morphine equivalent dose (MED) of 90 milligrams or more
- 75% decline in claimants prescribed a MED of 500 milligrams or more
We also made major progress in uncovering medical fraud and billing waste, and quickly set up controls to prevent further loss or harm. As a reflection of this progress, we have dramatically increased the number of referrals of suspected fraud we sent to the department’s Office of Inspector General beginning in 2017, and sent more in 2019 than ever before.
One key success story is the significant savings realized on pharmaceutical costs by cracking down on a questionable prescribing practice known as “combo kits.” These kits commonly include two readily available products, either two drugs or a drug and medical supplies. Combining the products as a single package allows a prescriber to omit the National Drug Code (NDC) assigned to those individual products and instead use only a singular, unique NDC for the package that bypassed the usual pricing mechanisms and allowed for a higher price to be charged. The same exact drugs and supplies within a kit, when purchased individually, are often available for a fraction of the cost. OWCP began an exception-based process where it automatically denies unique NDCs it has identified as questionable, triggering a human review for approval. Authorization is only provided when medical necessity is demonstrated and lower cost, commercially available alternatives are determined to be unsuitable or unavailable.
Continued monitoring of prescribing and dispensing practices has been revealing. Our data shows that over 30,000 attempts were made to fill these types of combined kits/drugs after OWCP initiated controls. Those controls resulted in a savings of over $50 million dollars.
OWCP is committed to serving our claimants, beneficiaries, and their families while being good stewards of taxpayer money. Our continued mission in protecting the health and well-being of America’s workers and safeguarding federal benefit programs will help drive effective outcomes.
Julia Hearthway is the Director of the Office of Workers' Compensation Programs.