Medicare pays Big Pharma for prescription drugs up to 32 days after patient is dead

Monday, January 25, 2016 by: Jonathan Benson, staff writer
Tags: Medicare, Big Pharma, prescription drugs

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(NaturalNews) American taxpayers are being taken out to the woodshed by the federal government's Medicare program, which was recently exposed for reimbursing drug prescriptions for dead people. Reports indicate that the fraudulent system currently allows payments for prescriptions filled up to 32 days after a patient has already died, costing taxpayers millions of dollars.

A report issued by the Department of Health and Human Services' (DHS) inspector general found that the policy, which was meant to cover hospitals and care centers that bill for prescriptions in bulk at the end of the month, is being widely abused. Expensive drugs like those for HIV and AIDS, for instance, are often billed even after a patient has died.

An investigation of Medicare claims filed in 2012 found that the program had disbursed drug payments for some 158 beneficiaries who had already died. Each patient's drug costs averaged $1,850, totaling nearly $300,000. In many cases, the prescriptions filled on behalf of these patients were for HIV/AIDS drugs, even though the patients did not have an HIV diagnosis.

Investigators tracked a total of 348 HIV prescriptions for dead beneficiaries, nearly half of which were filled more than a week after the patients had already died. In some cases, multiple prescriptions were filled for deceased beneficiaries who may or may not have had diagnoses for the diseases covered by the dispensed drugs, illustrating the depth of fraud involved.

"Drugs for deceased beneficiaries are clearly not medically indicated, which is a requirement for (Medicare) coverage," explains the report, which urges immediate reform to the program.

Medicare is a wasteful program that pisses away billions of taxpayer dollars annually

Since it was created in 2006, Medicare Part D, which delivers drugs through private insurance plans, has been a major source of government waste and fraud. It is estimated that $85 billion a year is spent on the program, a significant portion of which is going to reimburse fraudulent claims.

HIV isn't the only class of drugs involved in the fraud, either. Investigators say illegitimate claims likely span the gamut of available drugs, as the reimbursement loophole encourages medical crooks to file false claims for quick cash.

"The exposure for the entire Part D program could be significant," stated Miriam Anderson, one of the team leaders involved in creating the report, to The Associated Press (AP). "The payment policy is the same for all drugs, whether they are $2,000 drugs to treat HIV or $4 generic drugs."

Marilyn Tavenner, the Obama Administration's Medicare chief, responded to the report by saying that the industry needs to "revisit" the "32-day window" policy, which clearly undermines the integrity of the entire program and dangles like a carrot before greedy and unscrupulous medical entities billions of hard-earned taxpayer dollars.

"Considering the enormous number of Part D drugs, a change in practice could result in significant cost savings for the program and for taxpayers," concluded the investigative team.

"CMS [Centers for Medicare & Medicaid Services] will continue discussions with the industry with a goal of reducing the margin to the absolute minimum given current industry billing practices and system constraints," added Tavenner to The Washington Times.

Sources for this article include:

http://bigstory.ap.org

http://www.washingtontimes.com

http://health.wusf.usf.edu