CMS slow to investigate PDP fraud

October 15, 2007

OIG report finds the Centers for Medicare & Medicaid Services was slow to respond to fraud allegations against prescription drug plans and lacked an antifraud strategy.

An investigation into antifraud and abuse measures for the Medicare Part D program by the HHS Office of Inspector General (OIG) found that in 2006, CMS relied primarily on complaints to identify fraud and abuse. The report also noted that many complaints against prescription drug plans were not investigated in a timely manner. According to the report, nearly one-fourth of the more than 6,000 complaints received by Medicare Drug Integrity Contractor (MEDIC) remained open due to insufficient staff. OIG also pointed out that complaints to the 1-(800) MEDICARE hotline were not tracked. OIG recommended that CMS "develop a comprehensive safeguard strategy" to prevent fraud and abuse by Medicare Part D PDPs.

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