FOR IMMEDIATE RELEASE
CMS Media Affairs
October 7, 2005
The New Medicare Prescription Drug
Program: Attacking Fraud and Abuse
The Centers for Medicare &
Medicaid Services (CMS) is expanding its efforts in
fighting fraud and abuse in Medicare by using state of
the art systems and expertise to prevent problems before
they occur in the new Medicare prescription coverage.
Through a three-pronged approach,
CMS will fight fraud and abuse and help people with
Medicare protect themselves even before the new drug
coverage begins on January 1. The approach uses new and
innovative techniques to monitor and analyze data to
help identify fraud; work with law enforcement,
prescription drug plans, consumer groups and other key
partners to protect consumers and enforce Medicare’s
rules; and provide basic tips for consumers so they can
protect themselves.
Preventing Fraud and Abuse
With recommendations from experts
in law enforcement and other fraud and abuse and program
integrity experts and organizations, CMS is now working
with eight Medicare Rx Integrity Contractors (MEDICs)
that possess specialized skill sets enabling them to
find fraud, waste and abuse in the new prescription drug
program. These contractors will assist CMS by:
-
Analyzing data to find
problems that may indicate fraud or abuse could be
occurring;
-
Investigating potential
fraudulent activities surrounding enrollment,
eligibility determination or distribution of the
prescription drug benefit;
-
Investigating unusual
activities that could be considered fraudulent as
reported by CMS, contractors, or beneficiaries;
-
Conducting fraud complaint
investigations; and
-
Developing and referring
cases to the appropriate law enforcement agency as
needed.
The eight MEDICS are:
-
Delmarva Foundation for
Medical Care, Inc.
-
Electronic Data Systems
Corporation (EDS)
-
IntegriGuard, LLC
-
Livanta, LLC
-
Maximus Federal Services,
Inc
-
NDCHealth
-
Perot Systems Government
Services, Inc.
-
Science Applications
International Corporation (SAIC)
CMS has also taken steps to
resolve concerns and premature marketing actions by
prescription drug plans, including issuing warning
letters to Part D contractors and working with state
regulators to enforce marketing agent licensure
requirements.
Working With Law Enforcement
CMS is continuing to take strong
steps to combat waste, fraud and abuse in Medicare, and
is incorporating those steps into the new drug benefit.
Joining CMS in that effort are Medicare beneficiaries,
health care providers, and state and federal law
enforcement agencies such as the Department of Health
and Human Services Office of the Inspector General, the
Federal Bureau of Investigation (FBI), and the
Department of Justice.
The expanded efforts are paying
off. In one case, CMS referred to local law enforcement
reports of a scheme to sell drug benefit cards to people
with Medicare in which people asked beneficiaries for
bank card information. In another case, which also was
referred to law enforcement, people asked for bank and
other personal financial information in an attempt to
offer assistance with the new prescription drug
coverage.
Tips for Beneficiaries
Any Medicare beneficiary who
suspects fraud should call 1-800-MEDICARE
(1-800-633-4227), local State Health Insurance
Assistance Program (SHIP) or a local law enforcement
agency.
Medicare beneficiaries also need
to be aware of how to protect themselves against
identity theft. CMS has released “Quick Facts About
Medicare Prescription Drug Coverage and Protecting Your
Personal Information,” to help beneficiaries learn some
of the key ways they can protect themselves. (Fact sheet
is attached and can be found at
http://www.medicare.gov/Publications/Pubs/pdf/11147.pdf
)
Anyone with Medicare who finds
that someone is inappropriately using their personal
information should contact: 1-800-MEDICARE and The
Federal Trade Commission’s ID Theft hotline at
1-877-438-4338 to make a report (TTY users should call
1-866-653-4261). Beneficiaries who feel in danger for
any reason should call their local police department
immediately.
For more information about ID
theft protection, visit
www.consumer.gov/idtheft.
