The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

From the Office of Inspector General (OIG), U.S. Department of Health & Human Services

Prescription Drug Fraud

Beneficiaries have the option of the Part D prescription drug benefit. This has been a wonderful advantage for seniors to help in their medication needs. However, this has also opened the door for new and unprecedented fraud attempts.

How the Scam Works

  • One area of concern in Part D fraud is prescription shorting. This is where a fraudulent pharmacy routinely dispenses prescriptions a few pills short. In a large prescription the pharmacist hopes the beneficiary will not notice. If the pharmacist does this repeatedly, the pharmacy can steal a lot of money from Medicare because Medicare is billed for the full amount.
  • In a similar scheme, a fraudulent pharmacy may fill a partial month’s drug supply and ask the beneficiary to come back for the rest. The pharmacist then bills Medicare twice in one month for the full amount.
  • A new prescription drug diversion tactic is to talk a beneficiary into getting a prescription from his physician for a narcotic. It is then filled and billed to Medicare. The beneficiary is then paid cash for the script and the drugs are cycled back through the pharmacy or sold on the street.

How to Fight Back

  • Although time-consuming, consider counting your pills when you first get the prescription filled to make sure you were not shorted on the amount.
  • Do not participate in prescription drug diversion fraud. It is highly illegal and criminal behavior and can get the participating beneficiary into severe legal trouble as well.

Report Suspected Fraud

To report suspected fraud, click here.

 

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