By RICARDO
ALONSO-ZALDIVAR February 14, 2020Wayne Partlow)
WASHINGTON
(AP) — A government watchdog is launching a nationwide probe into how marketers
may be getting seniors’ personal Medicare information aided by apparent misuse
of a government system, officials said Friday.
The
audit will be formally announced next week said Tesia Williams, a spokeswoman
for the Health and Human Services inspector general’s office. It follows a
narrower probe which found that an electronic system for pharmacies to verify
Medicare coverage was being used for potentially inappropriate searchers
seemingly tied to marketing. It raised red flags about possible fraud.
The
watchdog agency’s decision comes amid a wave of relentlessly efficient telemarketing
scams targeting Medicare recipients and involving everything
from back braces to DNA cheek swabs.
For
years, seniors have been admonished not to give out their Medicare information
to people they don’t know. But a report on the inspector general’s initial probe,also
released Friday, details how sensitive details can still get to marketers. It
can happen even when a Medicare beneficiary thinks he or she is dealing with a
trustworthy entity such as a pharmacy or doctor’s office.
Key
personal details gleaned from Medicare’s files can then be cross-referenced
with databases of individual phone numbers, allowing marketers to home in with
their calls.
The
initial audit focused on 30 pharmacies and other service providers that were
frequently pinging a Medicare system created for drugstores.
The
electronic system is intended to be used for verifying a senior’s eligibility
at the sales counter. It can validate coverage and personal details on millions
of individuals. Analyzing records that covered 2013-15, investigators
discovered that most of the audited pharmacies, along with a software company
and a drug compounding service also scrutinized, weren’t necessarily filling
prescriptions.
Instead,
they appeared to have been tapping into the system for potentially
inappropriate marketing.
Medicare
stipulates that the electronic queries — termed “E1 transactions”— are supposed
to be used to bill for prescriptions. But investigators found that some
pharmacies submitted tens of thousands of queries that could not be matched to
prescriptions. In one case, a pharmacy submitted 181,963 such queries but only
41 could be linked to prescriptions.
The
report found that on average 98% of the electronic queries from 25 service
providers in the initial audit “were not associated with a prescription.” The
inspector general’s office did not identify the pharmacies and service
providers.
Pharmacies
are able to access coverage data on Medicare recipients by using a special
provider number from the government.
But
investigators found that four of the pharmacies they audited allowed marketing
companies to use their provider numbers to ping Medicare. “This practice of
granting telemarketers access to E1 transactions, or using E1 transactions for
marketing purposes puts the privacy of the beneficiaries’ (personal
information) at risk,” the report said.
Some
pharmacies also used seniors’ information to contact doctors treating those
beneficiaries to see if they would write prescriptions. Citing an example, the
report said, “The doctor often informed (one) provider that the beneficiary did
not need the medication.”
The
inspector general’s office said it is investigating several health care
providers for alleged fraud involving E1 transactions. Inappropriate use of
Medicare’s eligibility system is probably just one of many paths through which
telemarketers and other sales outfits can get sensitive personal information
about beneficiaries, investigators said.
A group
representing independent drugstores expressed support for the investigation.
“It’s about time,” said Douglas Hoey, CEO of the National Community Pharmacists
Association. “We welcome the effort to clean up this misbehavior.” Hoey said
some local pharmacists have complained of what appear to be sophisticated
schemes to poach customers who take high-cost drugs.
The
watchdog agency began looking into the matter after the Centers for Medicare
and Medicaid Services, or CMS, asked for an audit of a mail order pharmacy’s
use of Medicare’s eligibility verification system.
In a
formal response to the report, CMS Administrator Seema Verma said CMS retooled
its verification system last year so it automatically kicks out queries that
aren’t coming from a pharmacy. More than a quarter-million such requests have
been rejected, she wrote.
Medicare
is committed to ensuring that the system is used appropriately, Verma added. The
agency can revoke access for pharmacies that misuse the privilege and is
exploring other enforcement options.
The
inspector general’s office acknowledged Medicare’s countermeasures but said it
wants to see how effective they’ve been.
Health
care fraud is a pervasive problem that costs taxpayers tens of billions of
dollars a year. Its true extent is unknown, and some cases involve gray areas
of complex payment policies.
In
recent years, Medicare has gotten more sophisticated, adapting techniques used
by financial companies to try to head off fraud. Law enforcement coordination
has grown, with strike forces of federal prosecutors and agents, along with
state counterparts, specializing in health care investigations.
Officials
gave no timetable for completing the audit.
No comments:
Post a Comment