Tuesday, July 14, 2015

OIG Reports Highlight Medicare Part D Integrity

Dianne De La Mare

OIG has released a report, Ensuring the Integrity of Medicare Part D, which summarizes the agency’s work on Medicare Part D and provides an update on CMS’ efforts to address the weaknesses in Part D program integrity. The report highlights the importance of ensuring the integrity of CMS’ Part D program through proactive efforts to detect and prevent fraud, waste, and abuse. The availability and proactive use of data are essential to identifying several things, including program vulnerabilities and providers with questionable billing. It also helps target program integrity resources to the areas of greatest vulnerability.

OIG also has released another report, Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D, which summarizes the spike in spending on commonly abused opioids over the last decade. The report targets pharmacy-related fraud schemes regarding opioids and identifies “geographic hotspots” for certain non-controlled drugs. It highlights what the OIG deems as “questionable billing” related to frequently abused opioids. Since 2006, Medicare spending for commonly abused opioids has grown faster than spending for all Part D drugs, according to OIG. OIG investigations have identified pharmacy-related fraud schemes in Part D, such as drug diversion, billing for drugs that are not dispensed, and kickbacks. While pharmacy-related fraud schemes often involve commonly abused opioids, they can also involve non-controlled drugs. OIG found that more than 1,400 pharmacies had questionable billing for Part D drugs in 2014.

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