Originally published June 11 2005
U.S. government wary of fraud in new prescription drug plan
by Mike Adams, the Health Ranger, NaturalNews Editor
The U.S. government's new prescription drug coverage plan for the elderly will begin in January, and experts are worried individuals and companies will try to defraud the government. The division of Health and Human Services (HHS) estimates drug companies and pharmacies could try any number of rip-offs, including not fully filling prescriptions, pushing more pricey prescription drugs and billing Medicare for branded drugs but filling prescriptions with generics. HHS has been granted a one-time bonus of $25 million to help fight fraud when the new drug plan comes out, which will cost the government $720 billion in the next decade.
Because they're already busy going after the much smaller drug program--a warm-up to the big act--in place today.
The 2003 Medicare law included, for the first time in the 40-year-old program's history, broad prescription coverage.
To start, people over 65 could apply for discount cards good for 25% off and for some other subsidies.
(Even legitimate issuers of the cards were not permitted to hustle them door-to-door.)
Then callers weighed in from other states, reporting cases of insurers and pharmacy benefit managers (PBMs) enrolling Medicare beneficiaries without their consent and billing them the $30 enrollment fee--or trying to lure them into other services and products, like medical devices, that Medicare reimbursed.
One operator tried to pay pharmacies a fee for directing patients to its card, also verboten.
Then there was the alleged scheme by Eileen and Leonardo de Oliveira, involving Canadian and U.S. telemarketers, who bilked 103 people in Illinois of $90,000 by offering them bogus cards, then forwarded their checking account numbers to the De Oliveiras' Florida company, which debited the accounts, according to Illinois Attorney General Lisa Madigan.
She charged them civilly with consumer fraud; the De Oliveiras deny any wrongdoing.
In November an expected 29 million people 65 and older will start enrolling in Medicare's fully launched prescription drug insurance plan, costing an estimated $720 billion over the first decade.
"This is the largest new social benefit program in the history of the country, and it is going to take effect not in pieces but all at once," says James Sheehan, the associate U.S. Attorney in Philadelphia, who has overseen 500 health care fraud cases, including the $330 million settlement by the former SmithKline Beecham for fraudulent billings, and the government's current case against Medco Health Solutions, alleging kickbacks and false claims.
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