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(Health-NewsWire.Net, June 26, 2015 ) West Palm Beach, FL -- Medicare's popular prescription drug program is still battling against fraud and abuse, according to new reports from the inspector general of Health and Human Services. There have been several initiatives set in place to prevent abuse, however the abuse and fraud has continuously run rampant. A number of pharmacies were charged with health care fraud and conspiracy to commit fraud, including several in Miami.
These reports had been released in wake of the arrests of 44 pharmacy owners, doctors, and others, who all had been accused of "bilking" the Part D portion of the program. The reports revealed more insight on the extent of the fraud which had been taking place, as well as preventative tactics federal regulators should take to help end it. The first report found that over 1,400 pharmacies had questionable billing practices in 2014, prescriptions for commonly abused opiates had risen, and New York and Los Angeles were hotspots for questionable prescribing practices, according to Health News Florida.
In a second report the inspector general insisted that Medicare adopt several reforms that they've resisted in the past including: requiring health plans to report all potential fraud and abuse to CMS and CMS's fraud monitoring contractors, expand reviews for questionable drug prescribing, and restricting patients from doctor shopping.
Two years ago ProPublica reported on how weak oversight by the Centers for Medicare and Medicaid Services (CMS) allowed allowed abusive prescribing practices and blatant fraud to occur in Part D. As a result, Medicaid promised to enforce a more aggressive approach to analyzing their own data.
Medicare Part D is responsible for providing drug coverage for 39 million seniors and disabled people, and costs $121 billion in the year of 2014. According to reports Part D is the fastest-growing component within the Medicare program. Health insurers are responsible for administering Part D under contract from the federal government, however CMS is responsible for overseeing it.
According to Health News Florida, CMS has been taking the initiative to strengthen their tactics against preventing fraud in the Part D program. In April, CMS launched a web-based tool which enables CMS, law enforcement, and health plans to share information, as well as coordinate actions against pharmacies which are considered high risk. CMS also shared that they are planning to monitor potentially fraudulent activity within geographic hot spots, such as New York and Los Angeles.
A medical associate from West Palm Beach Drug Rehab comments "I am very hopeful that CMS will stay true to it's word and significantly help create a decline in fraud and abuse of the Medicare Part D program. The people who are abusing the system are the same people who are helping get prescription drugs in the hands of those who do not have a prescription and recreationally use prescription drugs. We have to do something to help put an end to the prescription drug abuse epidemic in our country, starting with ending the abuse of Medicare Part D."
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