New anti-fraud efforts in Medicare Part D

The Obama administration is touting new efforts to combat fraud and abuse in Medicare Part D, estimating they will save $1.6 billion in program funds over the next 10 years.

The Centers for Medicare and Medicaid Services (CMS) will now require doctors who prescribe drugs in Part D to enroll in Medicare or have an official record of opting out.

The agency will also revoke Medicare enrollment for providers that have a history of abusive clinical practice.

These providers could include doctors with a pattern of convictions for malpractice, for example, or those who have been subject to certain disciplinary actions by state licensing boards.

The measures are intended to cut down on abusive or fraudulent prescribing in Part D, the prescription drug program for seniors, and were finalized a 487-page regulation released Monday.

The rule also announced plans for Part D to release new healthcare data in line with recent disclosures about Medicare doctor billings and hospital charges. The move will likely see a backlash from providers.


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