Medicare Part D Fraud is Alive and Well in the USA

Implemented in 2006, Medicare Part D, also referred to as the Medicare Prescription Drug Program, provides drug coverage for tens of millions of elderly and disabled Americans.

Under the program, private insurance companies—referred to as Part D Sponsors—provide prescription drugs to eligible beneficiaries either directly or through pharmacy benefit managers (so-called “PBMs”), and then submit claims to Medicare for the drugs’ cost. 

Fraud can occur under Medicare Part D in many ways.

Some of the more common types of fraud occurring under the Medicare Part D program include:

  • Billing for drugs not actually provided.

  • Billing for drugs not covered by Medicare.

  • Billing for brand name drugs when generic drugs are provided instead.

  • Billing for drugs—especially opioids and other controlled substances—diverted for illegitimate purposes.

  • Billing for expired drugs.

  • Billing for drugs dispensed without a prescription, or with a falsified prescription.

  • Billing for drugs dispensed with prescriptions from unauthorized, excluded, or non-existent healthcare providers.

  • Billing for drugs provided in quantities that exceed approved limits.


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    • You are right. Doctors and hospitals are over charging Medicare. However, mediscam calls are just as bad. They are relentless and the more you tell them to put you on their do not call list the more they call you even though that is illegal. Medicare would be in a much better place if these calls were banned. They will ask you a question to get you to say yes. It is a scam.
      Never say yes on these calls because they will use that to fraudulently bill items in your name so that if you should later need these items you will not be eligible.

      Liked by 3 people

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