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Medicare paid $32m for questionable HIV prescriptions, investigators find

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5071 (Published 07 August 2014) Cite this as: BMJ 2014;349:g5071
  1. Michael McCarthy
  1. 1Seattle

Medicare, the US health insurance plan for elderly and disabled people, paid out $32m (£19m; €24m) in 2012 for dubious HIV drug prescriptions, a new report has found.1

The report, by the Office of Inspector General (OIG) at the US Department of Health and Human Services, is one of a series detailing serious fraud and abuse in the Medicare Part D prescription program.

The series of investigations has looked at pharmacies that billed extremely high dollar amounts or numbers of prescriptions for each beneficiary or provider; physicians who prescribed extremely high numbers of prescriptions or high percentages of Schedule II drugs, such as oxycodone; drug benefit managing companies that paid for Schedule II refills, which by law require a new …

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