Dive Brief:
- The HHS Inspector General's office has released a new report finding that the Medicare Part D prescription drug program may have been bilked for millions in fraudulent HIV prescriptions.
- The report finds that more than half of approximately 1,600 Part D beneficiaries who received HIV treatments in 2012 had no record of having the condition, having HIV lab tests performed or even visiting the prescribing provider. The most suspicious cases involved beneficiaries receiving inordinate amounts of HIV medication from multiple pharmacies.
- All told, the IG identified about $30 million in questionable HIV/AIDS spending in 2012 alone.
Dive Insight:
Doctors and providers are consistently under the microscope when it comes to fraudulent practices such as unnecessary testing or medical "upcoding." The new IG report underscores the flip side of fraud—when consumers either take advantage of their benefits or potentially steal beneficiaries' identities in order to make a profit off of Medicare.
"While some of this utilization may be legitimate, all of these patterns warrant further scrutiny," said the report authors. "These patterns may indicate that a beneficiary is receiving inappropriate drugs and diverting them for sale on the black market. They may also indicate that a pharmacy is billing for drugs that a beneficiary never received or that a beneficiary's identification number was stolen."
The fraud was particularly concentrated in the New York and Miami areas. These are among the regions that federal officials monitor closely due to historical instances of fraud.