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Medicare RAC Focuses on Medicare Advantage, Prescriptions

Janice Simmons, for HealthLeaders Media, July 19, 2010

In its report released last month, for instance, the OIG found that more than 18 million prescription drug records in 2007 had invalid prescriber identifiers, he told the Senate Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security. With these identifiers, which represented 2% of all Medicare Part D claims, pharmacists were paid more than $1.2 billion in one year.

One invalid prescriber identifier that did not meet format specifications was a string of nine zeroes: However, this single invalid identifier accounted for nearly 40,000 prescription records worth $3.7 million in 2007, Vito said.

The Centers for Medicare and Medicaid Services' (CMS) implementation of National Provider Identifiers—the standard method now being used to identify prescribing physicians on Part D claims—and its agreement to take steps to address recommendations in the latest OIG report indicates "the agency plans to address these vulnerabilities," Vito said.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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