NHCAA conference focuses on the future of fraud enforcement

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.

Enforcement officials are also keeping a close eye on counterfeit EHRs to support higher fraudulent payments, and fraud fighters are using social media sites such as Yelp to root out fraud.

For more:
- read the Bloomberg BNA article
- here's James L. Swann's Twitter feed

Related Articles:
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