Integrity contractor learns of thousands of Part D abuses

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The Medicare Drug Integrity Contractor, which was hired last October to monitor fraud, waste and abuse in the Medicare Part D program, has received more than 5,000 fraud and abuse complaints.

Health Integrity said it has investigated numerous cases of long-term care pharmacists who have directed residents into a plan with which the pharmacists had a relationship. The contractor also has referred to law enforcement cases involving rogue agents and brokers, drug-seeking beneficiaries and pharmacists creating flat copayments for all Part D patients. Health Integrity is a wholly owned subsidiary of the quality improvement organization Delmarva Foundation.

Part D plans are required to notify the integrity contractor if they suspect illegal activity. Cases that must be referred beyond the MEDIC first go to the U.S. Department of Health and Human Services Office of Inspector General, or in some instances to the FBI or a U.S. attorney. State insurance commissioners usually receive rogue agent/broker cases.