Performance Improvement 2009. Do Safeguards Prevent or Detect Prescription Drug Plan Fraud and Abuse?

01/01/2009

This study determined what safeguards were implemented during fiscal year 2006 to prevent and detect fraud and abuse in Medicare prescription drug plans. Statute requires performance of financial audits of drug plans contracted to provide drug benefits to Medicare beneficiaries and holds considerable discretion in structuring safeguards for the program.

The Office of Inspector General found that the agency implemented safeguard activities throughout fiscal year 2006; however, further development or application of these activities is needed. The agency relied largely on complaints to identify potential fraud and abuse; however, not all complaints were investigated timely. Further, limits to legal authority, jurisdiction, and the agency’s ability to monitor enrollees switching plans complicated its efforts to safeguard Medicare Part D prescription drug plans.

Report Title: CMS's Implementation of Safeguards During Fiscal Year 2006 To Prevent and Detect Fraud and Abuse in Medicare Prescription Drug Plans http://oig.hhs.gov/oei/reports/oei-06-06-00280.pdf
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 8997

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