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Medicare Compliance & Reimbursement

PHARMACEUTICALS:

Part D Fraud A Priority For CMS

Published on Mon Sep 26, 2005

Agency to use innovative techniques to for fraud detection.

The Centers for Medicare and Medicaid Services wants providers' help to spot phony Part D cards and shady prospective beneficiaries to prevent waste, fraud and abuse in the upcoming prescription drug benefit.

Nearly three months before the new Medicare prescription drug benefit will begin, CMS announced Oct. 7 it is already preparing for fraud complaint investigations. CMS wants beneficiaries, health care professionals and Medicare prescription drug plans to keep an eye out for fraud in the coming months.

The agency is working with eight Medicare Rx Integrity Contractors, which the agency selected for their specialized skills in:

• analyzing data to detect fraud;
• investigating potential fraudulent enrollment activities and unusual activities that CMS, contractors or beneficiaries report;
• conducting fraud complaint investigations; and
• referring the cases to the appropriate law enforcement agencies.

Important: CMS has also issued warning letters to Part D contractors to stop PDPs' premature marketing, and state regulators and CMS are strictly enforcing marketing agent licensure requirements.

Find it online: For more information, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1690.
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