PCMA: Anti-Fraud Report Highlights Concerns About ACA Implementation

Last week’s sweeping Medicare fraud busts provided a platform for the Pharmaceutical Care Management Association to raise questions about what it considers efforts to reduce accountability and oversight of independent pharmacies. (The busts were unrelated to independent pharmacies and were allegedly related to organized crime.)

To bolster its case, the PCMA—which represents pharmacy benefit managers—points to a whitepaper issued earlier this month by the National Health Care Anti-Fraud Association (NHCAA), Combating Health Care Fraud in a Post-Reform World: Seven Guiding Principles for Policymakers.

NHCAA, a public/private public interest organization, estimates that annual financial losses due to healthcare fraud are between $70 and $234 billion—and that doesn’t even factor in the harm to patients.

As the Affordable Care Act is implemented over the coming years, the NHCAA wants an increased focus on healthcare fraud: "Any effort to truly reform our healthcare system without seriously and thoughtfully addressing healthcare fraud will not be true reform," the paper states.

The Act includes several reforms that will allow both government agencies and private insurers to better detect, investigate, and prosecute suspected fraud, the report says, noting that "it is imperative that the focus on healthcare fraud contained in the legislation is sustained."