The U.S. Department of Health and Human Services (HHS) says that Medicare spent over $30 million in 2012 on possibly dubious AIDS medication costs. The HHS investigation flagged 1,578 Medicare beneficiaries that questionably received AIDS medications. More than half of those flagged had never received an HIV diagnosis, had not visited labs to monitor the use of the prescribed medications, or received medical services from any of the prescribers.
The report highlights the lax oversight of Medicare Part D – which cost taxpayers $65 billion in 2013 – and the billions wasted on needlessly dispensed drugs.
Below are some of the most egregious instances of AIDS medication Medicare fraud cited in the investigation:
- A fraudster in Miami visited nearly 30 different pharmacies to fill prescriptions of HIV drugs. Sixteen different health care practitioners wrote the scripts. The amount of drugs dispensed was roughly 10 times what the average patient gets in a year and worth nearly $200,000.
- One patient received $17,500 worth of AIDS medication in one day then did not fill a single prescription for the same medication for the rest of the year. The patient was prescribed double the recommended dose of five HIV drug ingredients.
- A 77-year-old Detroit woman reportedly filled prescriptions for 10 different AIDS medications worth $33,500. No official record exists of the woman having HIV or visiting the doctors that prescribed the meds.
- Two Miami pharmacies filled prescriptions for HIV medications to 321 Medicare beneficiaries, collecting over $350,000 for the meds. Most of the prescriptions were for women around the age of 74, who are more than two decades older than the average HIV patient receiving meds through Medicare.
The issue of AIDS medication exploitation extends beyond pharmacies and doctors, though the report is quick to highlight that, occasionally, fraudulent pharmacies will bill for AIDS meds, not dispense them, then bill a second time for them. Patients themselves are also abusing the system, as the report noted, because some of the AIDS meds have psychoactive effects that can enhance the effect of certain painkillers.
“These patterns may indicate that a beneficiary is receiving inappropriate drugs and diverting them for sale on the black market,” the report states. “They may also indicate that a pharmacy is billing for drugs that a beneficiary never received, or that a beneficiary’s identification number was stolen.”
The report highlights the need for whistleblowers to step up and report fraud if they see it, especially among practitioners and pharmacies. Blowing the whistle on egregious fraud like this saves taxpayer money and could provide you with a generous financial reward. If you have seen instances of overbilling for prescriptions or billing for drugs that were never dispensed, you should contact an experienced whistleblower attorney to discuss the matter.