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Latest Report Reveals Increasing Problem of Medicare Prescription Fraud

As the federal government continues to focus on sweeping fraud out of the Medicare system, the latest report from the Department of Health and Human Services’s Office of Inspector General highlights how big a problem fraud has become in the popular Medicare prescription program. What does this mean for the average health care professional? It means to expect greater scrutiny of any billing or prescription-related order sent to pharmacies and other drug providers.

The Medicare optional prescription program – better known as Part D – is a benefit available to Medicare beneficiaries. As of 2013 over 39 million beneficiaries were enrolled in the program, and that number continues to increase. In fact, the report found that spending for Part D drugs (meaning the money paid to pharmacies for their product) doubled from 2006 to 2014, from $51.3 billion to $121.1 billion. Part D is the fastest growing component of the overall Medicare program. Within this unprecedented level of spending, the report found some troubling patterns that indicate fraud and drug diversion: 1) spending for commonly abused opioids has grown faster than any other Part D drugs; 2) geographic hot spots exist for certain drugs; and 3) very high billing has occurred from specific pharmacies.

Drug diversion is an especially dangerous form of Medicare fraud. As the report noted, the increased prescription spending on commonly abused opioids — i.e. narcotics – is impossible to ignore. Nearly $7.8 billion of the Part D spending went to such highly desirable narcotics like oxycodone, fentanyl, morphine, and other acetaminophen-based drugs. With such drastically increasing numbers, it is not hard to imagine the authorities interpreting them to mean that there is significant fraud and diversion of drugs for illegal purposes and markets.

The report also highlighted the billing trends that indicated high levels of pharmacy fraud beyond drug diversion. These include kickbacks and fraudulent billing. More than 1,400 pharmacies were flagged as engaging in questionable practices in 2014. This subsection of providers billed more than $2.3 billion last year.

As yet another aspect of the Medicare system faces national scrutiny, state and federal authorities will focus their attention accordingly. This means increasingly stringent adherence to billing rules will be critical, due to the likelihood of law enforcement’s immediate flagging of any provider or pharmacy that may show the slightest hint of fraudulent or questionable practices. An experienced health care fraud defense attorney can help you assess the risk of your current practice.

If You Think You May Need A Lawyer, YOU DO. Call Now!

Are you looking for a skilled attorney who can help defend you against fraud charges in either state or federal court? Please contact Attorney Tony Moss at the Tony Moss Firm, L.L.C. to discuss these or any other defense matters. He has locations in Miami and Fort Lauderdale, and is prepared to put his experience to work for you.

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