Senate Government Affairs Subcommittee Fraud and Abuse in Medicare Prescription Drug Program Movie Review

Medicare Fraud, Abuse and Waste

Senate Government Affairs Committee: Medicare Prescription Drug Program

This memorandum is written with the purpose of exploring the Medicare prescription drug program that was enacted in 2003 under the Medicare Modernization Act. While the program has seen great success, with 85% of its participants believing that it is a good program, its complexity has made it vulnerable to fraud, waste, and abuse. There have been claims that appropriate antifraud safeguards will be implemented to guard against these issues but the critical and basic antifraud safeguards are not yet in place despite the fact that this program has entered into its fifth year of service.

It is imperative that plans to address waste, fraud, and abuse come to fruition and are implemented in a thorough and timely manner. This is important not only to protect our financial interests but it also ensures that these programs are not utilized for criminal activities which causes harm to the system as a whole. This memo begins by outlining the history of the development of a prescription drug program for Medicare beneficiaries. It will then explore the waste, fraud, and abuse that exist in the program, and conclude by identifying how these issues can be addressed with Congressional support and action.

Medicare Part D: History and Implementation

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for only $8.97. The Medicare prescription drug program arose out of the recognized need to increase prescription coverage beyond that of inpatient hospital stays and a few outpatient uses to the 40 million elderly and disabled persons who are enrolled in Medicare (Health Policy 2001). The rising costs of prescription drugs to Medicare recipients required Congress to contemplate the appropriateness of adding prescription drug coverage to Medicare benefits. Persons without prescription drug coverage were found to pay the most for their prescriptions, 15% more than their insured counterparts, placing an already vulnerable population at increased risk (Health Policy, 2001).

Movie Review on Senate Government Affairs Subcommittee Fraud and Abuse in Medicare Prescription Drug Program Assignment

Most generally agreed that there was a need to find a way to implement prescription drug coverage into the Medicare system but what that should look like was less clear. Many Medicare beneficiaries had purchased prescription drug coverage from HMOs to help with the rising costs of pharmaceuticals as well as their continued health decline. Yet there was still a large portion of the population, more than 9 million beneficiaries, which still did not have coverage (Health Policy, 2001). This was further compounded on January 1, 1998 when almost half of the HMOs providing coverage decided to stop providing this type of coverage claiming that they received inadequate payments from Medicare (King, 2010).

There have been several attempts at proposals to increase… [END OF PREVIEW] . . . READ MORE