I am glad to see "waste, fraud and abuse" being talked about in the debate on health care reform and I think addressing it is something everyone can agree on. I certainly know there are vast amounts of prescription drugs wasted every day by people who don't use them or don't use them properly. Pharmacy staff are all too familiar with the customers who believe that if their copay is $10 then that must be what the drug costs. We also know lots of people will take a few doses of something, decide it doesn't work, and never touch it again. I was reminded of this the other day when I watched a 3-month supply of a prescription leave the pharmacy --- cost, over $800, copay, $3.
A few months ago I saw a "60 Minutes" segment on Medicare fraud --- a guy talking about stealing millions from Medicare by submitting fraudulent claims for wheelchairs, artificial limbs, etc., through a fake company. He said it was like taking candy from a baby. Estimates of Medicare fraud go up as high as 70+ billion dollars a year (that's BILLion). And of course fake 'pharmacies' are right in there too. The report mentioned certain areas of the country, like south Florida, where it's a huge problem.
I think our government should make it the highest priority to go after this stuff. Talk about creating jobs, too --- lets get armies of field inspectors out there! They would pay for themselves in one day. They wouldn't even need a whole lot of training; in fact, people could work out of their homes, couldn't they? They could screen suspicious claims or concentrate on certain areas of the country. They could call up the person on whose behalf the claim was submitted...."Say, did you in fact receive that $7000 customized wheelchair from FakeIt Medical Supply?" If they say no, well ---- boom, that's money straight back in to the Treasury. We're talking about saving billions here. Am I oversimplifying this? I think it would be a blast!
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6 comments:
All good points. I wish they would. And nail the unscrupulous scum to the wall. They give all of us a bad name.
I get irritated when a customer complains about her $25 copay for a drug that is $1000 per ml (yes you read that right, $1K for 1 ml of this particular drug for this person's RX that she has the nerve to complain about). Ignorance appears to be universal.
murgatr
Pharm Tech RDC'06
Overprescribing, moral hazard (patients over utilizing healthcare because it is 'cheap' with low-copays), and blatant fraud as you described are some problems we need to address to really fix this mess.
This is a great idea! Customers complain about their insurance and how bad their coverage is. They need to be thankful that they have coverage these days! It seems that the government needs to focus their attentions not on passing alleged healthcare reform, but on focusing on the criminals that brag about their fraudulent activities on national television programs!
In some cases, all they would have to do is pay someone to drive around and look for some of these businesses that specialize in providing the medicare medical equipment and diabetic supplies. Instead, they harass legitimate pharmacies over technicalities such as the physician calling in a prescription for test strips for 100 test strips and the pharmacy not having a signature on file for them.
Just letting you know (if you haven't realized already!) that you are on the list of Health and Life's top pharma bloggers =)
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