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Let’s talk about prescription drug fraud

Prescription drug fraud is a consistent trend in Medicare. Criminals continue to exploit Medicare Part D due to the lucrative nature of prescription drug diversion and pharmacy scams. There are many types of prescription drug schemes, but pharmacy fraud primarily occurs when Medicare is billed for a medication that was not received or a beneficiary is intentionally given a different medication than what was prescribed.

The NYS Senior Medicare Patrol (SMP) receives calls from individuals asking what to do in challenging situations like this. The SMP program educates Medicare beneficiaries on how to protect themselves from fraud and abuse and is the go-to when people suspect they’ve been billed incorrectly.

“This type of fraud is why it is so crucial for beneficiaries to review their Medicare Summary Notices (MSN) or Explanation of Benefits (EOB) and report abuse, fraud, and errors to the NYS SMP,” said Tiffany Erhard, NYS Senior Medicare Patrol Outreach Counselor.

Report potential pharmacy fraud, prescription drug abuse, or errors if you see charges for:

¯ Prescription drugs (including refills) that were never picked up, delivered, or even prescribed;

¯ Prescription drugs (occasionally controlled substances such as opioids) that were prescribed by a health care provider you have never seen;

¯ Amounts beyond the quantity you were prescribed;

¯ A different prescription drug (often a more expensive drug) than the one you were originally prescribed or a drug that is not approved by the U.S. Food and Drug Administration.

Additional examples of pharmacy fraud are:

¯ A pharmacy intentionally provided you less medication than you were prescribed;

¯ A pharmacy issued you expired drugs;

¯ A pharmacy provided and billed for an expensive compounded medication, including topical pain creams, when a traditional or less expensive prescription was ordered by your provider.

Prevention begins with each beneficiary. Stay vigilant and review your information so you can detect any discrepancies. Report any findings to the NY Senior Medicare Patrol and help in the fight against Medicare Fraud. They also provide educational presentations and can help with questions, concerns, or complaints about potential fraud or abuse.

Call the NYS SMP Helpline and talk to Tiffany at 800-333-4374.

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