“Prescription drug fraud plagues our healthcare system and Medicare is no exception,” Sebelius said during a conference call about reducing government waste and fraud that was hosted by the White House Office of Management and Budget. Sebelius was joined on the call by Deputy Attorney General James Cole of the Justice Department and Deputy Secretary of the Treasury Neal Wolin of the Treasury Department.
During the call, Sebelius cited a recent Government Accountability Office report that found about 170,000 Medicare beneficiaries received prescriptions from five or more doctors from drugs that are used frequently, such as OxyContin and Percocet. And while not all of those instances are fraudulent, there are cases in which patients either abuse the drugs or sell them. According to HHS, painkillers such as OxyContin are the fifth most filled classes of drugs in the Medicare program, with spending totaling about $3.9 billion in 2009.
HHS' guidance to prescription drug plans also indicates how plans can use processes such as prior authorization, retrospective medical review, and prescribing for fewer than 30 days (with help from prescribing practitioners) to identify fraud.
The call was meant to highlight the Obama administration's efforts to fight fraud and misuse of federal dollars, and it followed a Cabinet meeting with Vice President Joe Biden. The U.S. Justice Department reports that it recovered about $5.6 billion in fraud this year, of which more than $2.9 billion was in healthcare fraud alone.