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HHS announces plan to prevent prescription medication fraud

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Medicare Set Aside News - HHS Announces a Plan to Prevent Prescription Medication Fraud

HHS Announces that it will crack down on Prescription Drug Fraud by directing Medicare to utilize all tools available.

Yesterday, the Obama Administration announced recovery of over $5.6 billion in fraudulent payments in fiscal year 2011, a 167 percent increase from 2008. President Obama's health care reform law includes new resources and tools to help fight fraud in Medicare and Medicaid, and to protect taxpayer dollars. In addition, the Centers for Medicare and Medicaid Services (CMS) is taking steps to strengthen controls to identify and prevent prescription drug fraud and abuse in the Medicare Part D program.

CMS released a notice to Part D prescription drug plan sponsors that contains information and guidance to immediately take steps to stop prescription drug misuse and fraud. Pain killers like OxyContin are the fifth most filled classes of drugs in Medicare, with spending in 2009 totaling $3.9 billion. Recently, the Government Accountability Office identified evidence of fraud and drug abuse in Medicare for these types of drugs, which pose a threat to public health as well as the federal budget. The plans were directed to:

  • Investigate and Stop Payment for Suspect Claims
  • Use Tools to Help Manage Proper Utilization of Drugs
  • Limit Prescriptions to 30-Day Doses
  • Enforce Tough New Rules and Sentences for Criminals
  • Utilize New Resources to Fight Fraud
  • Create Better Coordination across the Government
  • Sharing Data across the Government
  • Enhanced Penalties to Deter Fraud and Abuse
  • Enhanced Screening and Other Enrollment Requirements
  • Targeting High Risk Entities such as Medicare Home Health and Medicare Hospice
  • New Focus on Compliance and Prevention
  • Expanded Competitive Bidding and Prior Authorization for Durable Medical Equipment Providers

Our quality control efforts and the utilization of our RiskPro® technology have provided our clients with the most up-to-date anti-fraud capability during the past 20 years. We are one of the leading firms in the country for these efforts, and we look forward to working with our clients and Medicare to eliminate fraud, abuse, and waste in the Workers Compensation and Liability claims and insurance industry.

Click here for the CMS Fraud Prevention Toolkit.

Call us for more information about your specific questions related to this important HHS message.

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