Medicare Part D: Measures Needed to Strengthen Program Integrity Testimony of Ann Maxwell Assistant Inspector General

Tuesday, August 18, 2015
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law


On July 14, 2015, Ann Maxwell, Assistant Inspector General for Evaluation and Inspections of the Office of Inspector General (OIG), U.S. Department of Health and Human Services (HHS), gave testimony to Congress on the Medicare Part D Program. She presented before the United States House of Representatives Committee on Energy and Commerce and the Subcommittee on Oversight and Investigations.  Her testimony focused on fraud, waste and abuse trends in the Medicare Part D Program and recommendations to address the underlying vulnerabilities. With more than 39 million Americans depending on the program for their prescription drugs costing over $120 billion a year, the OIG is taking aggressive measures to combat fraud.


The Medicare Part D Program is Vulnerable to Fraud.

In June of this year, the OIG deployed more than 300 special agents and law enforcement personnel to execute arrest and search warrants for Medicare fraud across the country.  To date, it was the largest national health care fraud takedown. It resulted in more than 240 people being charged with defrauding the Medicare and Medicaid programs.  Much of the fraud involved prescription drugs and those charged included doctors and pharmacy owners.  Twenty-eight individuals from South Florida were charged with Part D fraud totaling more than $38 million in Medicare overpayments.  

To read Marshall's testimony in full, click here.


Changes CMS Can Make to Protect the Integrity of the Medicare Part D Program.

Since Part D went into effect, the OIG has raised concerns about oversight and made a number of recommendations to the Centers for Medicare & Medicaid Services (CMS).  The OIG recommendations center around two main themes:

        (1)    Leveraging Part D data to identify vulnerabilities.

        (2)    Employing additional tools to enhance the oversight of the Part D program.


CMS Should Take Action on the OIG's Recommendations.

CMS is responsible for improving the program's effectiveness and protecting its beneficiaries.  To do so, CMS should take action on OIG's recommendations and employ all the tools at its disposal.  Expect this to involve more audits, more action by ZPICs and MFCUs, and more health care subpoenas being issued.  To learn more about Medicare Part D fraud, read one of our past blogs here.


Contact Health Law Attorneys Experienced in Handling Medicare and Medicaid Audits, Investigations and other Legal Proceedings.

Medicare and Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicare fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.




Comments?

What do you think of these large crackdowns on Medicare Part D fraud? Do you think they work as a deterrent for others committing health care fraud? Please leave any thoughtful comments below.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


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8/18/2015

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