OIG Finds That Many Medicare Beneficiaries With Opioid Use Disorder Did Not Receive Treatment

Opioid-related overdose deaths in the United States reached an all-time high in 2020.  The COVID-19 pandemic has had a negative impact on beneficiaries’ mental health that, in turn, may have increased the number suffering from opioid use disorder. The Department of Health and Human Services Office of the Inspector General (OIG) conducted a review to determine the extent to which Medicare beneficiaries with opioid use disorder received medication and behavioral therapy through Medicare in 2020.   

The OIG analyzed Medicare Parts B, C, and D claims and found that of the approximately one million Medicare beneficiaries who were diagnosed with opioid use disorder in 2020, less than 16 percent received medication to treat their opioid use disorder. Also, less than half of the beneficiaries who received medication also received behavioral therapy.  

The OIG concluded that the findings evidence a need to increase the number of Medicare beneficiaries receiving treatment for opioid use disorder and recommended that the Centers for Medicare and Medicaid Services (CMS) take the following steps:

1. Conduct additional outreach to beneficiaries to increase awareness about Medicare coverage of opioid use disorder;
2. Take steps to increase the number of providers and opioid treatment programs for those with opioid use disorder;
3. Assist the Substance Abuse and Mental Health Services Administration (SAMHSA) by providing data about the number of beneficiaries receiving buprenorphine in office-based settings and the geographic areas where they remain underserved;
4. Take steps to increase utilization of behavioral therapy among beneficiaries receiving medication to treat opioid use disorder;
5. Create action plan and take steps addressing in opioid use disorder treatment disparities; and
6. Collect data on the use of telehealth in opioid treatment programs.

CMS concurred with four of the recommendations.

For more information on this topic, please contact Richard Kusserow at [email protected].

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 3,000 health care organizations and entities in developing, implementing and assessing compliance programs.