By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Fraud and abuse continue to dog Medicare’s Part D program, despite a surge of initiatives launched to prevent them, according to a new report issued by the Office of Inspector General (OIG), Department of Health and Human Services (HHS). With more than 39 million Americans depending on the program for their prescription drugs costing over $120 billion a year, the OIG is taking aggressive measures to combat fraud.
On July 14, 2015, Ann Maxwell, Assistant Inspector General of HHS, gave testimony to Congress on the Medicare Part D Program. She presented before the United States House of Representatives Committee on Energy and Commerce and the Subcommittee on Oversight and Investigations. Her testimony focused on fraud, waste and abuse trends in the Medicare Part D Program and recommendations to address the underlying vulnerabilities.
The Medicare Part D Program is Vulnerable to Fraud.
In June of this year, the OIG deployed more than 300 special agents and law enforcement personnel to execute arrest and search warrants for Medicare fraud across the country. To date, it was the largest national health care fraud takedown. It resulted in more than 240 people being charged with defrauding the Medicare and Medicaid programs. Much of the fraud involved prescription drugs and those charged included doctors and pharmacy owners. Additionally, 28 individuals from South Florida were charged with Part D fraud totaling more than $38 million in Medicare overpayments.
According to one of OIG’s reports, more than 1,400 pharmacies had questionable billings for opioid drugs, and a number of cities had higher than average billings for certain medications last year. To read the full report, click here. To read Marshall’s testimony in full, click here.
What Does This Mean for Pharmacists and Pharmacies?
CMS is responsible for improving the program’s effectiveness and protecting its beneficiaries. To do so, CMS should take action on OIG’s recommendations and employ all the tools at its disposal. Expect this to involve more audits, more action by ZPICs and MFCUs, and more health care subpoenas being issued. To learn more about Medicare Part D fraud and how it may affect you, read one of our past blogs here.
Contact Health Law Attorneys Experienced in Handling Medicare and Medicaid Audits, Investigations and other Legal Proceedings.
Medicare and Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicare fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.
Ornstein, Charles. “Fraud Still Plagues Medicare’s Prescription Drug Program.” NPR. (June 23, 2015). From:
What do you think of these large crackdowns on Medicare Part D fraud? Do you think they work as a deterrent for others committing health care fraud? Please leave any thoughtful comments below.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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