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Changes to Medicare Part D to reduce prescription fraud

May 22, 2014

A recent update to Medicare regulations has the Centers for Medicare and Medicaid Services (CMS) hopeful that $1.5 billion of organization funds will be saved from 2015 to 2024. The regulation, issued May 19, strives to cut fraud and abuse related to prescription drugs through Medicare Advantage and Part D.

According to a report by the Office of Inspector General, the Medicare Part D program paid nearly $5.5 million for prescriptions that were written by people who don't legally have the power to do so, such as dental hygienists and athletic trainers. A significant portion of the prescriptions were for controlled substances.

  • By June 1, 2015, physicians and other eligible providers have to enroll in Medicare or have a record of opting out of the program for prescriptions to be covered under Part D.
  • The CMS is able to revoke enrollment from providers who are putting patients at risk, abusing their power to prescribe or violating Medicare requirements in another way. Additionally, the CMS can withdraw Medicare enrollment from physicians who have their Drug Enforcement Administration certificate
  • More rewards and incentives will be offered for providers who encourage healthy aging through illness and injury prevention as well as efficient use of health care resources.

"The final rule will give CMS new and enhanced tools in combating fraud and abuse in the Medicare Part D program so that we can continue to protect beneficiaries and taxpayers," said CMS administrator Marilyn Tavenner in a statement.