Medicare Will Target Rx Fraud in 2006

Fearing an upsurge in pharmacyreimbursement fraud when the MedicarePart D prescription drug programtakes effect next year, Medicare officialshave announced the creation ofseveral new operating units. The aim ofthese units will be "to identify problemareas through trend analysis of claimsdata, and to oversee potential fraudareas in the Discount Drug Card andPrescription Drug programs."

Testifying at hearings of the SenateHomeland Security Subcommittee,Centers for Medicare and Medicaid Services(CMS) Financial ManagementDirector Tim Hill told Congress thatthe newly created divisions are among"several specific actions [that] havebeen taken by CMS to ensure that federaldollars are being properly spentand fraudulent billings are stoppedwhen they are detected."

Part of the crackdown will involvethe establishment of a new CMS satelliteoffice in Los Angeles to help "curtailfraudulent spending in high-riskareas," Hill said.

In addition, the CMS official servednotice that pharmacies that have beeninvolved in Medicaid billing abusesmay be flagged for special scrutinyunder the new Medicare drug program."For the first time, Medicare claimsand Medicaid claims are being jointlydata-mined to identify fraud andabuse," Hill explained. "In many cases,a small number of crooked providersare exploiting both programs."

Mr. Rankin is a freelance medical writer.