Pharmacy and Prescription Drug Fraud: The New York StateWide Senior Action Council's "Medicare Fraud of the Month for June"

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New York StateWide Senior Action Council, Inc.

Jun 18, 2024, 09:00 ET

ALBANY, N.Y., June 18, 2024 /PRNewswire/ -- The New York StateWide Senior Action Council (StateWide), an organization dedicated to advocacy for the rights of seniors in New York State, today announced its Medicare Fraud of the Month for June: Pharmacy and Prescription Drug Fraud.

The StateWide Fraud of the Month is a component of the Senior Medicare Patrol (SMP), the definitive resource for New York State's senior citizens and caregivers to detect, prevent, and report healthcare fraud, errors, and abuse. StateWide is New York's grantee/administrator for this Federal Program.

"Pharmacy and Prescription Drug Fraud occurs when Medicare is billed for a medication that was not received or a beneficiary is intentionally given a different prescription drug than prescribed," explained Maria Alvarez, Executive Director of StateWide.

She added, "Here are some examples of Pharmacy/Prescription Drug Fraud:"

Providers Billing Medicare 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.
Medication amounts beyond the quantity you were prescribed.
Different prescription drug (often more expensive) than the one you were originally prescribed or issuing you a drug that is not approved by the U.S. Food and Drug Administration (FDA).

And if Pharmacies:

Intentionally provide less medication than prescribed or issue expired drugs.
Provide and bill for an expensive compounded medication, including topical pain creams, when a less expensive prescription was ordered by a provider.
Offer gift cards or other compensation to switch prescriptions over to a specific pharmacy.
Automatically refill a prescription no longer needed.
A prescription not picked up is billed to Medicare.

Alvarez continued, "Criminals, ranging from health care providers to drug trafficking organizations, continue to commit prescription drug fraud because it is profitable.

"Unfortunately, there is a strong illegal market for prescription drugs – including controlled drugs such as opioids and expensive prescriptions such as autoimmune medications like Xeljanz. Some prescription drugs are targeted because they can be combined with recreational and illegal drugs to enhance a high or hallucinogenic effect."

StateWide offers the following advice to seniors to protect themselves from Prescription and Drug Fraud:

Be sure your doctor has assessed your condition before prescribing you medication.
Do not give out your Medicare number or other personal information to unknown individuals requesting it for prescription drug services.
Be suspicious of unsolicited calls and offers for "free" or "discount" prescription drugs.
Read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) to watch for the names of unknown providers and billing of prescriptions and other services you did not receive.

If you notice a charge to your Medicare drug plan for prescriptions you did not receive (or for different drugs than the ones you were prescribed), report your concerns about possible fraud, errors, or abuse to the NYS Senior Medicare Patrol.

It offers a Helpline at 800-333-4374 or visit www.nysenior.org. Counselors are ready and willing to help!

The NYS SMP and its trained counselors and volunteers help educate Medicare beneficiaries in the fight against health care fraud. It also provides information and educational presentations.

It is estimated that Medicare fraud costs taxpayers over $60 billion dollars nationally per year. To help combat this illicit industry StateWide announced its Fraud of the Month program in 2022 to highlight these scams being perpetrated on the State's seniors.

SOURCE New York StateWide Senior Action Council, Inc.