Moving Forward: HHS to Shift its Focus to Prescription Drug Fraud

In its fight against Medicare fraud, HHS announced that it “will direct all Medicare prescription drug plans to use every tool at their disposal to prevent fraud.” HHS noted the increasing problem of doctor shopping, the abuse of OxyContin and Percocet, and prescription drug fraud. Importantly, HHS announced that it has asked “prescription drug plans to withhold payment on suspicious claims, including when enrollees use multiple doctors to obtain painkillers and narcotics.” HHS notes that in such instances of suspicious claims, while drug plans generally must promptly pay claims, the drug plan should withhold payment to pharmacies until it verifies the claim is valid. In a recent interview, Robert S. Iwrey of The Health Law Partners expressed the following concern: “While I applaud efforts to thwart the submission and payment of fraudulent prescription claims that significantly raise the costs of our health care, I am concerned that those drug plans that are motivated solely by the bottom line may misuse such pronouncement as an opportunity to avoid and/or at least delay payment under the guise of verifying the validity of the claims when they are actually more interested in circumventing the applicable prompt payment rules.”

For more information, please contact Robert S. Iwrey, Esq. at (248) 996-8510 or (212) 734-0128 or visit the HLP website.