Medicare Advantage Plans' Fraud Oversight Weak, Says OIG

One organization accounted for 78% of the total 1.4 million incidents of potential Part C and Part D fraud and abuse. Excluding the 95% of all reported incidents that were linked to three Medicare Advantage organizations, 134 organizations identified a total of 73,499 potential fraud and abuse incidents in 2009. Of those, 83% were linked to Part C. Those 134 organizations covered 9.9 million beneficiaries in 2009.

Size apparently was not a factor in organizations' ability to monitor waste and fraud. "For example, an organization with more than 250,000 enrollees identified 37 potential Part C fraud and abuse incidents and 8 potential Part D incidents. Another organization, which had fewer than 5,000 enrollees, identified 7,787 potential Part C fraud and abuse incidents and 154 potential Part D incidents," OIG said.

The 134 Medicare Advantage organizations reported 32 different types of Part C incidents in 2009. The most common related Part C was improper coding of services. The organizations identified 25 different types of potential fraud and abuse related to Part D, and inappropriate prescription dispensing was the most common.