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Thousands of pharmacies bilk Medicare for billions of dollars
By Catholic Online (NEWS CONSORTIUM)
May 10th, 2012
Catholic Online (www.catholic.org)
May 10th, 2012
Catholic Online (www.catholic.org)
Hundreds of pharmacies - 2,600, fleeced Medicare to the tune of $5.6
billion. In one of the most egregious examples, a Kansas drugstore
submitted one thousand prescriptions - each - for two patients in the
space of a year. According to the inspector general of the Health and
Human Services department, the corner drugstore is especially vulnerable
to fraud, partly because Medicare does not require the private insurers
that deliver prescription benefits to seniors to report suspicious
billing patterns.
The analysis scrutinized every claim submitted by the nation's 59,000 retail pharmacies during 2009, more than one billion prescriptions. Investigators were able to reveal contrasts between normal business practices and potential criminal behavior with statistical analysis.
"The findings call for a strong response to improve (program) oversight," the report said.
In written comments, Medicare administrator Marilyn Tavenner said the agency mostly agrees with the inspector general's call to action. Tavenner suggested that requiring private insurers to monitor and report suspicious activity could place a burden on the companies and may flood government officials with leads that turn out to be useless.
Medicare also said it has anti-fraud contractors that are already keeping close tabs on the program.
"We believe it is important to note that (the inspector general's) report identified what appeared to be questionable billing based on its own data analysis but did not determine any actual fraud committed by the pharmacies," Tavenner wrote.
The issue bespeaks an enormous lack of accountability where the typical citizen's personal health is at stake. "What we are seeing in the data is extremely concerning," Jodi Nudelman, a regional inspector general in New York said.
Her team will turn over the names of the 2,637 pharmacies it identified for follow-up. They are "extreme billers, when you look at their peers and compare them," Nudelman added.
On the positive side, only a small fraction of retail pharmacies, 4.4 percent were found to have telltale patterns of questionable billings. But in some parts of the country, the share was much higher, reaching nearly 20 percent of pharmacies in Miami, an area known as an incubator for Medicare fraud.
In Los Angeles, where 12 percent of pharmacies had questionable billings, one drugstore in a suburban strip mall billed Medicare more than $8.4 million, nine times the national average. That worked out to an average of 116 prescriptions per beneficiary.
© 2012, Distributed by NEWS CONSORTIUM.