Watchdog: Detroit Metro Hot Spot for Medicare Drug Fraud

» Get Patch’s daily newsletter and real-time news alerts.

Metro Detroit is one of four geographic hotspots for questionable Medicare prescription drug billing practices, according to an analysis by government watchdog released Friday.

The report from the inspector general of the U.S. Health and Human Services found 1,432 pharmacies nationwide that, together, had $2.3 billion in questionable drug billings, were “more likely to be independently owned and to be located in the New York, Miami, Los Angeles, and Detroit areas.”

The Detroit area, as well as Miami, Los Angeles and the Brooklyn area of New York, were targeted earlier this year by the Medicare Fraud Tax Force.

The report said 403 pharmacies billed for an extremely high number of prescriptions – 62 per beneficiary, compared to the national average of 23 – an indication the pharmacy may be billing for medically unnecessary drugs that may never have been provided to the beneficiary.

Almost 500 pharmacies billed for commonly abused opioids in an extremely high percentage of their prescriptions.One Detroit-area pharmacy billed for commonly abused opioids for 93 percent of its beneficiaries, amounting 58 percent of all of the pharmacy’s Part D prescriptions.

Related:

• 16 in Metro Arrested in Largest-Ever Medicare Fraud Sweep

Dr. Amy Bohnert, a psychiatry professor at the University of Michigan Medical School who studies opioid prescribing patterns and overdose prevention, told The Detroit news “that 93 percent is absolutely shocking.”

Bohnert said the findings raise serious public health concerns. “These are potentially lethal medications that are, through these routes, getting out to the communities in large numbers,” she said.

The study comes on the heels of a nationwide sweep, the largest Medicare fraud enforcement effort in history, resulted in 16 arrests in the Detroit metro area. The health-care providers – including six physicians, a social worker, a pharmacist and two physical therapists – were accused of taking more than $122 million in fraud and kickback schemes.

The Detroit News said charges have been filed in U.S. District Court for the Eastern District of Michigan against 381 individuals since 2009 when the Department of Justice began targeting the region. More than $881 in alleged false billings are at issue.

__________

Photo via Auntie P/Flickr