Reuters: Regulatory News: Medicare billing flagged at 4 pct of US pharmacies-govt

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Medicare billing flagged at 4 pct of US pharmacies-govt May 10th 2012, 18:24 Thu May 10, 2012 2:24pm EDT * Over 2,600 pharmacies exceed high-billing threshold-report * Independents 8 times more likely to be flagged than chains By Lewis Krauskopf May 10 (Reuters) - A U.S. government examination found questionble billing practices for Medicare prescription drug coverage at 4 percent of American pharmacies, particularly independent retail drugstores. The report was issued by the U.S. Health and Human Services' Office of Inspector General, which has previously found limited safeguards to prevent fraud and abuse in the Medicare drug program for seniors, known as Medicare Part D. The Office of Inspector General (OIG) examined billing records from 2009, the most recent full-year data was available. Government inspectors used eight measures to review the pharmacies, including average amount billed per beneficiary, average amount billed per prescriber and percentage of prescriptions for painkillers and other controlled substances that have the potential to be abused. In total, 2,637 retail pharmacies were found to have exceeded the threshold that indicated extremely high billing for at least one of the eight measures. "While some of this billing may be legitimate, all pharmacies that bill for such extremely high amounts warrant further scrutiny," the report said. Miami, Los Angeles and Detroit were the metropolitan areas of the country found most likely to have pharmacies where billing was at issue. In Miami, questionable billing was found 19 percent of pharmacies. The report also found that independent pharmacies were eight times more likely than chains to have questionable billing In response to the report, the National Community Pharmacists Association, which represents owners of more than 23,000 independent drug stores, said the report "lacks sufficient detail to evaluate the medical legitimacy and appropriateness of the claims reviewed." "As OIG itself notes throughout its report, there could very well be legitimate medical reasons behind many of the claims it has flagged," the NCPA said in a statement, adding it was still reviewing the report. For example, the pharmacist association said, independent pharmacies serve a disproportionately high number of long-term care and other patients who are prescribed more medications than the average Medicare beneficiary. "In responding to the OIG report, policymakers should proceed carefully to get at the heart of the issue without inadvertently burying pharmacists and patients in unproductive red tape," the NCPA said. The OIG report made several recommendations to improve oversight of the Medicare Part D program, including that the Centers for Medicare & Medicaid Services strengthen monitoring of pharmacies and the ability to identify pharmacies for further review, as well as following up on pharmacies identified as having questionable billing. Link this Share this Digg this Email Reprints

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