As improper payment rates increase across the board, federal officials are targeting areas of healthcare that are particularly vulnerable to fraud, including prescription drug schemes involving non-controlled drugs and high-priced specialty drugs, according to reports from the National Health Care Anti-Fraud Association's (NHCAA) annual conference.
Although the Office of Inspector General (OIG) remains concerned about prescription drug fraud involving addictive opiates, non-controlled drugs make up a massive chunk of Medicare Part D spending, according to Bloomberg BNA. The OIG previously reported that Part D spending has more than doubled in the past decade, reaching $121 billion in 2014; however, $113.2 billion of that spending was on non-controlled drugs.
High-priced specialty drugs are another major concern for government officials, offering a high return for fraudsters, Bloomberg BNA reported. In particular, officials are closely watching hepatitis C drugs that recently hit the market. Already, hepatitis C drugs have seen a 15-fold increase in expenditures over the past several years, reaching $4.5 billion in 2014.
Bloomberg BNA reporter James L. Swann also live-tweeted the NHCAA conference. He reported that the Centers for Medicare & Medicaid Services will release an upgraded version of its Fraud Prevention System later this year or early next, and that improper payment rates are up across the board. Medicaid saw a huge improper payment rate increase for 2015 (9.8 percent), up from 6.7 percent in 2014. Meanshile, Medicare Part C improper payments rose from 9 percent in 2014 to 9.5 percent this year, and Medicare Part D was 3.6 percent, up from 3.3 percent last year.
Hepatitis C spending goes through the roof
Survey: Specialty drug costs could rise 23% next year
With a laundry list of fraud concerns, Part D payments are far from perfect
Medicare, Medicaid improper payments top $75B in 2014