Investigation Uncovers Potential Medicare Fraud Involving HIV Meds

Thursday, August 7, 2014

I normally stick to blogging about global health topics, but since the U.S. is part of the globe (obviously), and HIV/AIDS medications are such an important topic in global health, it felt natural to comment on this story.

U.S. Health and Human services just published the results of an investigation into possible fraud involving ARVs (antiretrovirals, or HIV medications) that were paid for by Medicare's Part D. Medicare is America's health care program for the retired and disabled; Part D is the part of the program that covers prescription drugs. What makes this story unusual, however, is that it focuses on beneficiaries as the ones possibly committing fraud. From NPR:
  • In Detroit, a 77-year-old woman purportedly filled $33,500 worth of prescriptions for 10 different HIV medications. But there's no record she had HIV or that she had visited the doctors who wrote the scripts.
  • A 48-year-old in Miami went to 28 different pharmacies to pick up HIV drugs worth nearly $200,000, almost 10 times what average patients get in a year. The prescriptions were supposedly written by 16 health providers, an unusually high number.
  • And on a single day, a third patient received $17,500 of HIV drugs — and none the rest of the year. She got more than twice the recommended dose of five HIV drug ingredients.
The inspector general's report raises new questions about Medicare's stewardship of Part D. A ProPublica series last year showed that Medicare's lax oversight enabled doctors to prescribe massive quantities of inappropriate medications, wasted billions on needlessly expensive drugs and exposed the program to rampant fraud. Part D cost taxpayers about $65 billion in 2013.

Previous inspector general reports have criticized the way Medicare oversees doctors and pharmacies, but this one focuses on patients, who are not usually the focus of inquiries into fraud and abuse.

The investigation flagged 1,578 Medicare beneficiaries who received HIV medications worth $32 million in 2012.
Government-provided healthcare has been under intense scrutiny, and has come under a lot of fire, with the (sometimes botched) implementation of the Affordable Care Act over the last two years. Personally, I hope this doesn't generate too much negative publicity - after all, fraud will happen in programs this size, which is why these types of investigations are undertaken. I am at least encouraged by the fact that they published the results - unlike the CDC, whose laboratory safety slip-ups over the last decade only came to light when the anthrax incident blew up.

No comments :

Post a Comment