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Medicare Implements New Steps To Prevent Drug Card
Fraud
April 23, 2004 – Reports have been coming from
across the U.S. of fraudulent drug cards – claiming to be
Medicare-approved - being sold to senior citizens. The government is
now taking actions to stop the frauds and offer help to Medicare users.
Centers for Medicare & Medicaid Services
Administrator Mark B. McClellan, M.D., Ph.D. yesterday announced efforts
that CMS is undertaking to strengthen oversight of the Medicare-approved
Discount Drug Card Program.
CMS will monitor the activities conducted by the
Medicare-endorsed discount cards, which will start enrollment next month
and will start providing discounts in June. CMS will:
> Conduct weekly
updates on the covered drugs and drug prices provided by the card
sponsors to ensure there is no “bait and switch.” CMS will monitor
changes in overall drug prices and identify programs that stray from the
expected changes in the prices the card sponsors themselves pay, which
are based on the average wholesale prices. Drug card sponsors can only
increase the negotiated price for covered drugs if there is a change in
the sponsor’s costs, such as changes in the discounts, rebates or other
price concessions received from a drug maker or pharmacy.
> Log and
respond to beneficiary complaints against card sponsors received at
1-800-MEDICARE,
www.medicare.gov, from
state health insurance assistance programs (SHIPS), CMS’s regional
offices, state agencies or other partners. Consistent patterns of
beneficiary complaints may lead to sanctions or further penalties
against a drug sponsor.
> Conduct
“mystery shopping” of the card sponsor 1-800 numbers to ensure they are
charging beneficiaries the advertised enrollment fees, checking the
prices displayed on the Medicare drug price comparison website, and
following other federal guidelines.
“The vast majority of health care providers try to
do the right thing, so we are going to be very clear about our rules and
focus our efforts on those who intentionally seek to commit fraud,” said
Dr. McClellan. “As we improve Medicare and expand its benefits, we will
protect both Medicare beneficiaries and the Medicare trust fund from
unscrupulous individuals.”
Although Medicare beneficiaries cannot enroll in
any Medicare-approved drug cards until May 3, some beneficiaries across
the country have reported cases of unsolicited calls as well as
in-person solicitations from individuals or companies posing as Medicare
officials attempting to gain personal information with the intent to
scam. Cases have been reported in Alabama, Georgia, Idaho, Maine,
Massachusetts, Maryland, Nebraska, New York, Oklahoma, Pennsylvania,
Rhode Island, Virginia, and Washington. In many of these cases,
individuals received telephone calls or solicitations in their home,
purportedly for “Medicare” products. These are individual cases; CMS
has not identified any large-scale fraudulent drug card operations. In
its monitoring activities involving drug card fraud, CMS continues to
work closely with the Department of Justice, Federal Bureau of
Investigation, and the Office of the Inspector General as well as other
consumer protection agencies.
Dr. McClellan also discussed some facts that
consumers should know to help prevent fraud. “Medicare does not allow
legitimate drug cards to be marketed through unsolicited calls or
unsolicited visits to your home. Medicare beneficiaries, or anyone
else, for that matter, should never share personal information such as
their bank account number, social security number, health insurance card
number (or Medicare number) with any individual who calls or comes to
the door claiming to sell any Medicare related product,” said Dr.
McClellan. “If anything like this happens to you, or if you think you
might be the victim of a fraud for other reasons, you should call
1-800-MEDICARE, the Fraud Hotline of the HHS Office of the Inspector
General at 1-800-447-8477, or you local police department.”
“We have been working closely with health care
providers and our partners in law enforcement and oversight to reduce
fraud and abuse in Medicare, and we are extending those efforts to
Medicare’s new programs,” said HHS Secretary Tommy G. Thompson. “We are
implementing new steps to make sure that Medicare-endorsed drug cards
follow the rules, and we are continuing to keep watch for any drug card
scams.”
“Legitimate Medicare-endorsed discount cards are
coming soon, and if you have any questions about how you can get the
most help from this new program, call 1-800-MEDICARE any time, day or
night,” said Dr. McClellan.
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