Part D Fraud & Abuse
The OIG has issued a report examining the extent to which Medicare Drug Integrity Contractors (MEDICs) identify Medicare Part D prescription drug fraud and abuse. The OIG found that 87% of potential incidents identified by the MEDICs in FY 2008 were identified through external sources, such as complaints, rather than proactive methods such as data analysis. According to the OIG, the MEDICs’ use of innovative techniques for data analysis was hampered by problems with accessing and using Medicare prescription drug event and Part B data, along with the MEDICs lack of authority to directly obtain information from downstream entities such as pharmacies, pharmacy benefit managers, and physicians. The OIG made a series of recommendations to improve the MEDICs’ access to accurate and comprehensive data, some of which would require statutory and/or regulatory changes.
