Medicaid Drug Fraud: Drug Diversion Schemes And Pill MillsA pill millÓ operates when physicians, clinic owners, & pharmacists collect to defraud Medicaid by prescribing & distributing drugs mainly to obtain reimbursement. Patients are often knowing participants in these schemes, allowing use of their Medicaid recipient numbers for billing purposes in exchange for cash, drugs, or other inducements. This report assesses the extent of the drug diversion problem, the reasons it persists, & what actions are being taken to bring it under control. Charts & tables. |
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Page 2
... Act. To determine the extent of Medicaid prescription drug diversion, we
conducted a telephone survey of the 42 MFCUs” and visited four states reporting
significant pill mill problems: California, Florida, New York, and Results in Brief
Texas.
... Act. To determine the extent of Medicaid prescription drug diversion, we
conducted a telephone survey of the 42 MFCUs” and visited four states reporting
significant pill mill problems: California, Florida, New York, and Results in Brief
Texas.
Page 3
Texas. We interviewed officials at the state Medicaid agencies, Mfcus, state
licensing authorities, and appropriate Hhs regional offices. We also met with
representatives of the Department of Justice, the Hhs Office of the Inspector
General, Hcfa ...
Texas. We interviewed officials at the state Medicaid agencies, Mfcus, state
licensing authorities, and appropriate Hhs regional offices. We also met with
representatives of the Department of Justice, the Hhs Office of the Inspector
General, Hcfa ...
Page 12
Table l.1: Medicaid Fraud Control Units Citing Problems With Pill Mills | Ranked
by population in relation to 50 states Rank State Rank State 1 California 20
Minnesota 2 New York 21 Louisiana 3 Texas 23 Kentucky 4 Florida 28 Oklahoma
6 ...
Table l.1: Medicaid Fraud Control Units Citing Problems With Pill Mills | Ranked
by population in relation to 50 states Rank State Rank State 1 California 20
Minnesota 2 New York 21 Louisiana 3 Texas 23 Kentucky 4 Florida 28 Oklahoma
6 ...
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For example, officials in Texas said that Medicaid recipients paid physicians cash
for scrips that they had filled at local pharmacies. They sold the drugs—which
cost the pharmacy less than 50 cents per pill—on the street for as much as $85 a
...
For example, officials in Texas said that Medicaid recipients paid physicians cash
for scrips that they had filled at local pharmacies. They sold the drugs—which
cost the pharmacy less than 50 cents per pill—on the street for as much as $85 a
...
Page 32
We then focused our efforts on the four most populous states whose MFCU
Directors reported a significant pill mill problem: California, Florida, New York,
and Texas. We interviewed officials from the state Medicaid agencies, MFCUS,
state ...
We then focused our efforts on the four most populous states whose MFCU
Directors reported a significant pill mill problem: California, Florida, New York,
and Texas. We interviewed officials from the state Medicaid agencies, MFCUS,
state ...
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Common terms and phrases
abused drugs action Appendix assets audit BCCI bill Medicaid charges Civil Monetary Penalties CMPL Controlled Substances Controlled Substances Act court criminal curb defraud Medicaid Department of Justice detection Diversion Persists Divert Drugs drug benefit Drug diversion schemes Drug Enforcement Administration drug utilization review Economic Incentives example excluded Extent and Persistence False Claims Act federal agencies focused Fraud Control Units fraudulent HCFA health care fraud high-volume providers Human Services identify individuals Inspector involved Medicaid agencies Medicaid billings Medicaid drug diversion Medicaid Fraud Control Medicaid Prescription Drug Medicaid program Medicaid recipients Medicare MFCU officials middlemen million noncontrolled numbers offenders organized network overpayments patient brokers percent Persistence of Medicaid pharmacies pharmacist pill mill prescribing physician Prescription Drug Diversion prescription drug fraud prescription forms probation problems program losses prosecution pursued pursuit recover losses referred require restitution sanctions scrips state's suspect labs targeting Texas up-front controls Utilization Review York Zantac
Popular passages
Page 1 - At the federal level, the Health Care Financing Administration (HCFA) in the Department of Health and Human Services (HHS) administers...
Page 42 - In the final analysis, the commitment and institutional support of the secretary of the Department of Health and Human Services, the Office of Management and Budget, and the Congress are all essential to the successful implementation of a departmental comprehensive integrated health care statistics strategy.
Page 8 - One key element of such a strategy might be the designation of a unit within HCFA responsible for (1) conducting continuing evaluations of state initiatives...
Page 2 - For example, some pharmacists routinely added medications to customers' orders, keeping the extras for themselves or to sell to others. Clinics inappropriately provided Medicaid recipients with completed prescription forms (scrips) that were then traded for merchandise from local pharmacies or sold on the street to the highest bidder. Some pills costing 50 cents at the pharmacy were resold for as much as $85.
Page 3 - The drug fraud took many forms, including pharmacists who routinely added medications to customers' orders, keeping the extras for themselves or to sell to others; clinics that inappropriately provided Medicaid recipients with completed prescription forms (scrips) that were then traded for merchandise from local pharmacies or sold on the street to the highest bidder; and typical pill mill schemes in which recipients, in exchange for abusable drugs, allowed physicians, pharmacies, and labs to use...
Page 2 - ... by the Health Care Financing Administration ("HCFA") in the Department of Health and Human Services ("HHS").
Page 35 - Under the act controlled substances (narcotics and dangerous drugs) have been divided into five schedules on the basis of their potential for abuse, accepted medical use, and accepted safety under medical supervision. Substances included in schedule I are those with a high potential for abuse, no accepted medical use, and a lack of accepted safety. Those in schedules II through V decrease in potential for abuse and increase in accepted medical use. The placement of a drug in any one of these schedules...
Page 1 - Medicaid, the largest government health program for the poor, is a logical target of drug diversion because it typically includes prescription drugs in its covered services. It accounts for 80 percent of all federal spending on prescription drugs. In 1991, prescription drugs accounted for 7 percent of Medicaid spending — more than physicians' services, more than any noninstitutional benefit provided by the program.
Page 32 - The Chairman of the House Select Committee on Narcotics Abuse and Control testified...
Page 1 - In Florida and Texas, the recent rate of increase has been even greater, with expenditures more than doubling between 1987 and 1991.' The incentive to abuse the Medicaid drug benefit is considerable: some prescription drugs have psychological or physical effects similar to those of illicit drugs; others have substantial monetary value, and profiteers can divert them for resale through illicit channels. The pursuit of drug diversion...
Bibliographic information
| Title | Medicaid Drug Fraud: Drug Diversion Schemes And Pill Mills |
| Author | Timothy D. Crowe |
| Edition | illustrated |
| Publisher | DIANE Publishing, 2004 |
| ISBN | 0788102001, 9780788102004 |
| Length | 53 pages |
| Subjects | › Medical / Public Health |
| Export Citation | BiBTeX EndNote RefMan |