Medicare Part D

Latest Headlines

Latest Headlines

CMS sanctions Cigna over 'substantial failures' in Medicare plans

Federal regulators have banned Cigna from selling new Medicare products because of issues with its Part C and Part D plans that increased enrollees' out-of-pocket expenses which led to delays or denials in receiving medical services and prescription drugs.  

Amid a handful of overprescribing convictions, one doctor has a 30-year fraud history

A psychiatrist indicted for illegally selling prescriptions for nearly 10,900 pain pills has a history of illegal prescribing practices and Medicare fraud dating back 30 years, according to  lohud.com.

Youthful exuberance adds a unique twist to fraud schemes

Daniel Suarez, 24, will spend the rest of his twenties and early thirties in prison for stealing $21 million from Medicare Part D as part of pharmaceutical fraud scheme that began when he had barely turned 18. Suarez spent his money on luxury cars, while attempting to launder the stolen funds through FedEx trucks. His youthful exuberance conjures up comparisons the Martin Shkreli, now facing securities fraud charges after drawing in his own brand of attention. 

New CMS tool tracks trends for costliest drugs

Health insurers concerned about the rising cost of prescription drugs now will have access to a new tool that lets them--and the public at large--analyze spending trends on the medicines that cost the country's largest payer the most.  

NHCAA conference focuses on the future of fraud enforcement

As improper payment rates increase across the board, federal officials are targeting areas of healthcare that are particularly vulnerable to fraud, including prescription drug schemes involving non-controlled drugs and high-priced specialty drugs, according to reports from the National Health Care Anti-Fraud Association's annual conference.

Fraud, waste, abuse dominate the OIG's top 10 challenges

Half of the top 10 management and performance challenges identified by the Office of Inspector General in fiscal year 2015 have fraud, waste and abuse implications, according to a report released Tuesday.  

With a laundry list of fraud concerns, Part D payments are far from perfect

As one of the youngest government-run health programs, Medicare Part D has been around for less than a decade, meaning it's just reaching the beginning stages of adolescence. And, like most...

With a laundry list of fraud concerns, Part D payments are far from perfect

Medicare Part D has been in effect for nearly 10 years, but it has accumulated a staggering list of deficiencies when it comes to fraud, waste and abuse. Most notably, the Centers for Medicare & Medicaid Services does not require Part D sponsors to report fraud, making it difficult to determine how much waste exists within the program. In an editorial for  Forbes  last week, Merrill Matthews, a resident scholar with the Institute for Policy Innovation in Dallas, described how Medicare Part D should be the posterchild for efficiency because of its low improper payment rate. But Matthews fails to acknowledge the pervasive vulnerabilities the Office of Inspector General and others have identified within the Part D program that have made it a target for fraud and abuse. 

OIG's 2016 Work Plan targets Part D, med equipment fraud concerns

Medicare Part D pharmacy enrollment, drug reimbursement and durable medical equipment are among the new fraud and abuse focus areas targeted by the Office of Inspector General, according to agency's 2016 Work Plan.  

Pa. officials target doctor shopping to reduce opiate abuse

The increasing death toll tied to drug overdoses in Pennsylvania has prompted state senators and law enforcement officials to push for an alternate approach to prescribing pain medication in the state.