Medicare Part D Payments for Beneficiaries in Part A Skilled Nursing Facility Stays in 2006

摘要

Medicare Part D provides outpatient prescription drug coverage for Medicare beneficiaries who enroll. Part D covers most prescription drugs; however, it excludes drugs that are covered under Medicare Parts A or B. Specifically, Part D excludes drugs for beneficiaries in Part A SNF stays if the drugs were for use in the facility or to facilitate the beneficiaries discharge. The Centers for Medicare & Medicaid Services (CMS) has identified duplicate payments by Medicare Parts A and D as a potential vulnerability. CMS further states that billing multiple payers (e.g., Parts A and D) for the same prescription is an example of pharmacy fraud, waste, and abuse. This review determines the extent to which Medicare Part D paid for drugs for beneficiaries in Part A SNF stays in 2006.