Retail Pharmacies With Questionable Part D Billing.

摘要

The Medicare Part D program provides an optional prescription drug benefit to Medicare beneficiaries.1 The Centers for Medicare & Medicaid Services (CMS) contracts with private insurance companies, known as sponsors, to provide drug coverage to beneficiaries who choose to enroll in the program. In 2010, approximately 35 million beneficiaries were enrolled. In the 6 years since Part D began, the Office of Inspector General (OIG) and others have raised concerns about Part D billing. In several reports, OIG found that the program has limited safeguards in place and is vulnerable to fraud, waste, and abuse. Additionally, recent investigative cases have illustrated a variety of alleged fraud schemes by pharmacies. For example, a pharmacist who owned 26 pharmacies was charged with health care fraud and drug diversion. The owner allegedly paid physicians to write prescriptions that were medically unnecessary and to direct patients to fill them at his pharmacies. The pharmacies purportedly billed $37.7 million to Medicare. In another case, the owners of two pharmacies were charged with fraudulently billing Part D for $3 million for drugs that were never purchased by their pharmacies or dispensed to beneficiaries.