It's Real: Medicare Part D Fraud

Some things only exist in fairytales but Medicare part D fraud isn’t one of them. This is a very serious problem that has cost the country millions of dollars. Because it’s such a huge and almost uncontrollable problem, all Medicare part D members should be aware of it and how to do their part in stopping it.

When most people hear the word fraud, they normally think it won’t happen to them. When it does happen to them, they are surprised because it’s done in a very sneaky way that most people won’t catch. Although it’s sometimes hard to detect, it is very obvious to those that are aware of the problem. Medicare part D is a huge problem that can affect anyone that is enrolled in a Medicare part D plan.

What It Is and How to Spot It

Medicare part D fraud happens when an insurance provider is charged for a medication that doesn’t belong to the Medicare part D member or when a Medicare part D member gets medications filled on their prescription insurance for someone else. While there are many kinds of fraud, these are the most common types of Medicare part D fraud. When this happens, insurance benefits that are supposed to be used for the beneficiary only are being abused.

This type of fraud can go on for months or years before anyone realizes it. Many people that are innocently part of a fraud scam will realize this when they go to use their Medicare part D benefits and are told they are asked to pay a higher cost for their medicines before they should be asked to. It is during those times that people ask what medications have been filled against their Medicare part D insurance.

Members in this situation find that it can take days to correct this problem and get their medications for the price they are supposed to be. While it’s great when a pharmacist tells members what is going on with the cost of their medications, Medicare part D fraud can be caught much sooner. Medicare members that read their explanation of benefits each month will see when there are medications that don’t belong to them being put on their insurance.

Medicare members that fill prescriptions for others with their insurance are caught by their pharmacist, doctors or plan providers. When this happens, criminal charges can be filed and result in huge fines and/or prison time. It is illegal to use Medicare part D benefits for someone other than the beneficiary.

How to Report It

When Medicare part D fraud has happened, it is very easy to report. Medicare part D members should get a list of the medications that have been filled that don’t belong to them and tell their pharmacist they don’t belong to them. After notifying the pharmacist, members should call their part D plan providers and notify them of the issue. With that phone call, the fraud can be stopped and many of the charges can be taken off the member’s account.

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