OIG says Medicare Part D paying for invalid, illegal prescriptions


The Office of the Inspector General says criminals are exploiting weaknesses in the Medicare Part D program to obtain false prescriptions for schedule II medications, the Associated Press reports.

According to an examination of the Part D program by the OIG, Medicare has been unable to verify all of the prescriptions it pays for through the Part D program. Although pharmacists are required to enter an identifier number and submit it to the Centers for Medicare and Medicaid Services every time they fill a prescription, in many instances a dummy number is used or it is left blank.

"It's similar to placing a combination lock on a gate to protect what's inside but then allowing any combination to open the gate,'' said Robert Vito, a regional inspector general for the U.S. Department of Health and Human Services.


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The amount of drugs purchased by CMS with no or false identifiers was relatively small--$20.6 million in 2007, out of a total of $1.6 billion paid for schedule II drugs. Such items include narcotics that are widely trafficked illegally, like oxycodone and methadone.

CMS officials have agreed to fix the system and require an identifier or a Drug Enforcement Administration number to pay for a prescription.

For more:
- read the OIG report (.pdf)

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