HIV Medication Fraud is Rampant in the Medicare Part D System

After years of watching Medicare fraud cases pile up, the U.S. Department of Health and Human Services conducted an in-depth investigation of the government healthcare organizations’ paying practices. A recently released report on the investigation concluded that, in 2012, more than $30 million was spent by Medicare on questionable HIV medication costs.

Statistics like that aren’t quite as alarming as they might have been at one point, mainly because the rise in Medicare fraud in the recent past is alarming unto itself. What is fairly interesting are the types of fraud schemes outlined in the report – all of which have been successfully, albeit fraudulently, funded by Medicare Part D (the prescription program). Here are a few examples.

No HIV, but I Need HIV Meds – The report outlined a scam where a woman in Detroit was able to fill more than $33,000 in prescriptions for HIV drugs. The only problem is that she doesn’t have HIV!

Pharmacy Shopping Yields Extra Meds – One woman in Miami was able to buy almost $200,000 worth of prescriptions for HIV meds, allegedly written by 16 different doctors. She managed to fill all the scripts by going to 28 different drug stores to pick of the medications.

A Year’s Worth of Meds – In One Day? Another patient apparently was able to pick up more than $17,000 worth of HIV drugs in one day. However, she didn’t fill any prescriptions for those drugs for the entire rest of that year.

These are only some of the fraudulent schemes that involve HIV medications. The report outlines countless cases where Medicare was apparently blind to the ongoing fraud. Scams against the Medicare Part D program cost taxpayers closed to $65 billion in 2013. More than 50 percent of the patients counted in the report had no diagnosis of HIV and no lab tests on file to prove they were being monitored for HIV medication usage.

If you believe you have information that uncovers fraud against the government, you may be able to collect a portion of the funds recovered in a whistleblower case. Speak to the experienced qui tam lawyers at Begelman & Orlow, P. C. about your suspicions. We can help you determine if you have a whistleblower case worth pursuing in court.