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  • The Koyal Training Group: ‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan

    Communication, Communication Design

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    The federal government does little to stop schemers from stealing from Medicare Part D, the program that provides prescription drugs to more than 36 million seniors and disabled people.

    With just a handful of prescriptions to his name, psychiatrist Ernest Bagner III was barely a blip in Medicare’s vast drug program in 2009.

    But the next year he began churning them out at a furious rate. Not just the psych drugs expected in his specialty, but expensive pills for asthma and high cholesterol, heartburn and blood clots.

    By the end of 2010, Medicare had paid $3.8 million for Bagner’s drugs—one of the highest tallies in the country. His prescriptions cost the program another $2.6 million the following year, records analyzed by ProPublica show.

    Bagner, 46, says there’s just one problem with this accounting: The prescriptions aren’t his. “All of that stuff you have is false,” he said.

    By his telling, someone stole his identity while he worked at a strip-mall clinic in Hollywood, California, then forged his signature on prescriptions for hundreds of Medicare patients he’d never seen. Whoever did it, he’s been told, likely pilfered those drugs and resold them.

    “These people make more money off my name than I do,” said Bagner, who now works as a disability evaluator and says he no longer prescribes medications.

    Today, credit card companies routinely scan their records for fraud, flagging or blocking suspicious charges as they happen. Yet Medicare’s massive drug program has a process so convoluted and poorly managed that fraud flourishes, giving rise to elaborate schemes that quickly siphon away millions of dollars.

    Frustrated investigators for law enforcement, insurers, and pharmacy chains say they don’t see evidence that Medicare officials are doing much to stop it.

    “It’s kind of a black hole,” said Alanna Lavelle, director of investigations for WellPoint Inc., which provides drug coverage to about 1.4 million people in the program, known as Part D.

    Lavelle said her team routinely refers doctors and pharmacies to the contractor Medicare hires to pursue fraud. “Oftentimes we never hear back, positive or negative.”

    Since it started in 2006, Part D has been lauded for its success in getting needed medications to more than 36 million seniors and disabled enrollees. READ FULL ARTICLE

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