Unraveling Medicare and Medicaid Prescription Drug Fraud and Abuse

Abstract

With government spending on Medicare and Medicaid programs skyrocketing, their futures are questionable. Many politicians and political pundits are calling for intense oversight of these agencies to reduce fraud and abuse in the system and, consequently, rein in costs. Many medical providers’ fraudulent behaviors, which cost the medical community billions of dollars, stem from prescribing of pharmaceutical drugs to treat an illness or injury. Although this is part of the job of providers, some allow kickbacks from pharmaceutical companies or patient requests to cloud their clinical judgment. This article identifies several options for increased enforcement of laws concerning Medicaid and Medicare fraud and abuse of drug benefits, with great emphasis placed on the Integrated Data Repository currently under development by the federal government.