Not all of Medicare Part Ds plan sponsors have fully implemented fraud- and abuse-prevention programs, the Government Accountability Office reported. In addition, the CMS oversight of these programs has been limited, the GAO found.
The GAOs review of five Part D plan sponsors found that none of them had completely implemented all of the CMS required compliance plan elements and recommended measures for fraud and abuse prevention.
CMS officials said that they worked with Part D sponsors to help them develop fraud- and abuse-prevention plans that met the agencys compliance criteria. However, the CMS has yet to conduct any audits of the sponsors implementation of these plans, the GAO reported.
In comments, the CMS stated that insufficient resources have been one of the primary impediments to implementation of a robust oversight strategy. A report issued in July by the Senate Republican Conference estimated that Medicare pays upward of $60 billion a year to criminals who defraud the federal government.
The report cited a number of cases where Medicare was taken for millions of dollars, including instances where medical devices were billed multiple times and medications were ordered with no intent of ever reaching a patient. -- by Jennifer Lubell
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