Between 2008 and 2010, a doctor in Monroe, Michigan, prescribed more than five million prescription pain pills to hundreds of patients a day that he never saw in his clinic. He was charged in March 2011 with unlawful distribution of prescription drugs, including Oxycontin, a highly addictive pain medication, and $5.7 million in Medicare fraud, according to a U.S. Attorney in Michigan.
In October 2011, a doctor, a pharmacist, and 15 co-conspirators in California were charged with defrauding Medicare and Medi-Cal out of millions of dollars through a prescription drug ring that charged the government several times for the same pills.
Members of the ring used stolen or illegally obtained Medicare beneficiary cards to obtain prescriptions for expensive pharmaceuticals from a physician in Glencoe, California, according to a criminal complaint filed in a U.S. District Court in Los Angeles. Prescriptions were frequently written for Seroquel and Zyprexa, antipsychotic drugs that Medicare purchases from pharmacies for up to $2,800 a bottle.
An investigation by the Government Accountability Office found that hundreds of thousands of Medicare beneficiaries regularly “doctor hop,” having the same prescription for popular drugs filled by five or more physicians and paid for through Medicare Part D, which provides coverage for prescription drugs.
A Dallas, Texas, physician, the office manager of his medical practice, and five owners of home health agencies, were arrested February 28, 2012, for their alleged participation in a nearly $375 million health care fraud scheme involving fraudulent claims for home health services. In related action, the CMS announced it was suspending 78 more home health agencies based on charges of fraud made against them.
Healthcare fraud, waste and abuse cost the U.S. government an estimated $67 billion to $230 billion annually, making it the the nation's second largest white collar crime.
About $1 billion of the waste is attributed to Medicare expenditures for pharmaceutical drugs.
The federal government has enacted several polices in recent years to reduce fraudulent Medicare billing and wasteful expenditures for pharmaceuticals.
According to a 2011 report by the Government Accountability Office, "Medicare remains on a path that is fiscally unsustainable over the long term. This fiscal pressure heightens CMS’s [Centers for Medicare & Medicaid Services] challenges to reform and refine Medicare’s payment methods to achieve efficiency and savings, and to improve its management, program integrity, and oversight of patient care and safety. CMS has made some progress in these areas, but many avenues for improvement remain."
The federal government has adopted numerous policies to reduce fraudulent Medicare billing and curb waste including funding
Between 2008 and 2010, a doctor in Monroe, Michigan, prescribed more than five million prescription pain pills to hundreds of patients a day that he never saw in his clinic. He was charged in March 2011 with unlawful distribution of prescription drugs, including Oxycontin, a highly addictive pain medication, and $5.7 million in Medicare fraud, according to a U.S. Attorney in Michigan.
In October 2011, a doctor, a pharmacist, and 15 co-conspirators in California were charged with defrauding Medicare and Medi-Cal out of millions of dollars through a prescription drug ring that charged the government several times for the same pills.
Members of the ring used stolen or illegally obtained Medicare beneficiary cards to obtain prescriptions for expensive pharmaceuticals from a physician in Glencoe, California, according to a criminal complaint filed in a U.S. District Court in Los Angeles. Prescriptions were frquently written for Seroquel and Zyprexa, antipsychotic drugs that Medicare purchases from pharmacies for up to $2,800 a bottle.
An investigation by the Government Accountability Office found that hundreds of thousands of Medicare beneficiaries regularly “doctor hop,” having the same prescription for popular drugs filled by five or more physicians and paid for through Medicare Part D, which provides coverage for prescription drugs.
The Affordable Care Actsigned into law in 2010 provides $350 million in funding for tools to combat fraud including enhanced screenings and tighter enrollment requirements, increased data sharing across government agencies, expanded overpayment recovery efforts and greater oversight of private insurance abuses. These efforts are coordinated through the U.S. Department of Justice and the Department of Health and Human Services.
