Pharmacy & Prescription Fraud: The New York StateWide Senior Action Council’s “Medicare Fraud of the Month” for April

ALBANY, N.Y., April 19, 2023 /PRNewswire/ — The New York StateWide Senior Action Council (StateWide), an organization dedicated to advocacy for the rights of seniors in New York State, today announced its Medicare Fraud of the Month for March: Pharmacy & Prescription Fraud.

The StateWide Fraud of the Month is a component of the Senior Medicare Patrol, the definitive resource for New York State’s senior citizens and caregivers to detect, prevent, and report healthcare fraud, errors, and abuse. StateWide is New York’s grantee/administrator for this Federal Program.

“Pharmacy and Prescription Drug Fraud occurs when Medicare is billed for a medication that was not received or a beneficiary is intentionally given a different prescription drug than prescribed,” stated Maria Alvarez, Executive Director of StateWide. “Here are examples of Pharmacy and Prescription Fraud,” she added.

Medicare will be billed for:

• Prescription drugs (including refills) that were never picked up, delivered, or even prescribed.
• Prescription drugs (occasionally controlled substances such as opioids) that were prescribed by a health care provider you have never seen.
• Medication amounts beyond the quantity that was prescribed.
• Different prescription drugs (often more expensive) than the one that was originally prescribed or issuing a drug that is not approved by the U.S. Food and Drug Administration (FDA)

Pharmacies can also defraud Medicare by:

• Intentionally providing less medication than prescribed or issuing expired drugs.
• Providing and billing for an expensive compounded medication, including topical pain creams, when a less expensive prescription was ordered by a provider.
• Offering gift cards or other compensation to switch prescriptions over to a different pharmacy.
• Automatically refilling a prescription no longer needed.
• The prescription is not picked up, but the pharmacy still bills Medicare.

“Criminals, ranging from health care providers to drug trafficking organizations, continue to commit prescription drug fraud because it is profitable. Unfortunately, there is a strong illegal market for prescription drugs – including controlled drugs such as opioids and expensive prescriptions such as autoimmune medications like Xeljanz. Some prescription drugs are targeted because they can be combined with recreational and illegal drugs to enhance a high or hallucinogenic effect,” warned Alvarez.

Seniors can protect themselves by:

• Making sure their doctor has assessed a condition before prescribing medication.
• Never giving out Medicare numbers or other personal information to unknown individuals requesting it for prescription drug services.
• Being suspicious of unsolicited calls and offers for “free” or “discount” prescription drugs.

“It is important to read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) to watch for the names of unknown providers and billing of prescriptions and other services you did not receive. If you notice a charge to your Medicare drug plan for prescriptions you did not receive (or for different drugs than the ones you were prescribed), report your concerns about possible fraud, errors, or abuse to the NYS Senior Medicare Patrol,” Alvarez advised.

The NYS Senior Medicare Patrol has a hotline for people who believe they have been a victim of any Medicare fraud. Call 800-333-4374. Or visit nysenior.org. Certified counselors are ready to help answer any questions regarding Medicare benefits and issues.

It is estimated that Medicare fraud costs taxpayers over $60 billion dollars nationally per year. To help combat this illicit industry StateWide announced its Fraud of the Month program in 2022 to highlight these scams being perpetrated on the State’s seniors.

SOURCE New York StateWide Senior Action Council, Inc.