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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 adolescents, it's still searching for its identity.

Over the course of its short lifespan, Part D has faced plenty of hiccups. In June, for instance, the federal government arrested 243 people across the country connected fraud schemes that cost the government approximately $712 million. Forty-four of those people were accused of defrauding the Medicare Part D program.Description: http://imagec17.247realmedia.com/RealMedia/ads/Creatives/default/empty.gif/0

For many, the Department of Justice's fraud bust in June was a "coming of age" moment that served as an exclamation point at the end of a growing list of fraud, waste and abuse concerns dating back to the program's inception.

But not everyone saw it that way, it seems. In an editorial for Forbes, Merrill Matthews, a resident scholar with the Institute for Policy Innovation in Dallas, described how Medicare Part D should be the posterchild for efficiency, noting that it "clearly defies most government program stereotypes." After all, Part D boasts an improper payment rate of just 3.3 percent, according to the Office of Management and Budget (OMB), a far cry from its healthcare counterparts, Medicare A and B (12.7 percent) and Medicare Advantage (9 percent).

Based on those figures alone, Matthews is right. Part D remarkably outperforms almost any other government-run healthcare program. Unfortunately, the OMB figures don't paint the full picture.

>>Read the full commentary at FierceHealthPayer: Antifraud