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CMS steps up anti-fraud efforts in countdown to prescription drug coverage

Physician Practice Advisor, October 12, 2005

The Centers for Medicare & Medicaid Services (CMS) will use eight "Medicare Rx Integrity Contractors" to monitor and analyze data as part of its fraud prevention efforts as the prescription drug coverage date (January 1) nears.

"Even before the new drug coverage becomes available next year, we are working hard to protect Medicare beneficiaries and the American taxpayer from anyone who may seek to take advantage of this new program and Medicare beneficiaries," CMS Administrator Mark B. McClellan, MD, Ph.D, said in a press release. "We are building on the preventive steps we took with the Medicare-approved drug discount card and lessons learned, and we are working with law enforcement officials to stop people who take advantage of seniors, people with disabilities and the taxpayers."

The eight "Medicare Rx Integrity Contractors" will look for fraud in the new program and

• analyze data to look for suspicious trends
• begin the investigation of fraudulent activities surrounding the drug benefit
• refer cases to law enforcement as necessary

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