[Report] Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014

Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014.

….
More than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. In total, sponsors reported identifying 64,135 incidents of potential fraud and abuse between 2010 and 2012. Sponsors’ identification of such incidents varied significantly, from 0 to almost 14,000 incidents a year.

CMS requires sponsors to conduct inquiries and implement corrective actions in response to incidents of potential fraud and abuse; however, 28 percent of Part D plan sponsors reported performing none of these actions between 2010 and 2012. Although CMS reported that it conducted basic summary analyses of the data on potential fraud and abuse, it did not perform quality assurance checks on the data or use them to monitor or oversee the Part D program.
WHAT WE RECOMMEND
We recommend that CMS (1) amend regulations to require sponsors to report to CMS their identification of and response to potential fraud and abuse; (2) provide sponsors with specific guidelines on how to define and count incidents, related inquiries, and corrective actions; (3) review data to determine why certain sponsors reported especially high or low numbers of incidents, related inquiries, and corrective actions; and (4) share sponsors’ data on potential fraud and abuse with all sponsors and law enforcement. CMS did not concur with the first recommendation, partially concurred with the second and fourth recommendations, and concurred with the third recommendation.

 

Related articles

• Medicare’s Drug Program Needs Stronger Protections Against Fraud
• Medicare’s Drug Program Needs Stronger Protections Against Fraud, Watchdog Says

[Reblog] Phone Scam About Personal Safety Devices

[Reblog from the 16 January 2013 post at As Our Parents Age]

It appears that seniors are receiving phone calls that attempt to scare them into making personal safety device purchases with a credit card, and it feels like a scam. I received one yesterday on my mobile phone.

An urgent voice asks for a senior citizen noting that break-ins, robbers, medical emergencies or falls are scary and a free solution will make them safer. Moreover, the voice offers a solution that’s supported or endorsed by the American Heart Association, the American Diabetes Association, and the National Institute on Aging — three well-known and reputable organizations. To learn how to protect myself from all of these terrible problems the voice asks me to hit a number on my phone.

Well I am not a senior — yet — but I know a fair amount about media literacy, and I’ve spent countless hours telling my parents, my husband’s parents, and various other family members and friends, to hang up when they receive these urgent telephone calls asking them to make a purchase. However … I didn’t hang up because I was too intrigued. I pressed number one.

Next a reassuring woman’s voice explains that the Senior Emergency Care company – with a AAA rating from the Better Business Bureau and endorsements from all of the above organizations — is offering me free equipment and free registration and shipping — equipment that will help me avoid or prevent scary life situations such as crime and health emergencies. The personal safety device that she is selling would, she told me, can be worn around my neck and will make me feel and be safer.

The woman continues the call by explaining how the devices helps by calling emergency responders in any of those worrisome situations, and if I am wearing it I  will also receive a wellness check phone call once a day. While the equipment is free, she said, a monthly fee of 34.95 will pay the people who respond to the emergencies and make the wellness calls. She wanted me to buy my device right then and there and even put a little pressure on me to give her my credit card. I declined. I told the woman I would think about it and also talk with my parents, and I hung up.

Then I Googled Senior Emergency Care, the name she gave me when I asked about the company’s identity, I could not find it. But I did find this story about this phone pitch, Warning Over Personal Safety Systems Pitch, in the December 21, 2012  Milwaukee (Wisconsin) Journal Sentinel. So I also did a quick check of the Better Business Bureau, but could not find the company.

Sounds like a scam to me.

Personal safety devices are available through hospitals, through a variety of senior organization — in fact you can even purchase them at Costco.  Make sure that your family and friends purchase personal safety devices are from a trusted source and not from a cold phone call.

Feel free to share my description with other people who might be interested.

 

If you receive this call you can file a complaint with the Federal Trade Commission (FTC) or your state fraud protection agencies.

 

Consumer Health Digest Archive (and Links to Related Health Fraud Information Sites)

Enhancing Freedom of Choice through Reliable Health Information Subscribe to Consumer Health Digest

From the archive http://www.ncahf.org/digest12/index.html

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., with help from William M. London, Ed.D., M.P.H.. It summarizes scientific reports; legislative developments; enforcement actions; other news items; Web site evaluations; recommended and nonrecommended books; research tips; and other information relevant to consumer protection and consumer decision-making. The Digest currently has 11,082 subscribers. Items posted to this archive may be updated when relevant information becomes available.

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Issue #12-35, October 11, 2012

• Pediatricians warn against home trampoline use
• High-quality fluoride information posted
• “Life coach” loses suit against nutrition licensing board
• FTC halts dubious insurance plan

Issue #12-34, October 4, 2012

• Romney campaign embraces Lyme quackery
• Vitamin D supplementation fails to prevent colds
• Quantum quackery criticized

Issue #12-33, September 27, 2012

• Stem cell scammers plead guilty
• Prominent psychiatric critic dies
• Medifast subsidiary settles FTC charges

Issue #12-32, September 20, 2012

• Portland City Council votes to fluoridate.
• Physicist details why homeopathy is impossible
• Massachusetts will post more about disciplinary actions

Issue #12-31, September 6, 2012

• IOM publishes health-care system critique
• Ginkgo flunks another big Alzheimer’s prevention trial
• AMA specialty journals will be renamed in 2

 

Related Resources

• Don’t be fooled by health fraud scams (jflahiff.wordpress.com)
• Evaluating Health Information on the Internet (US National Cancer Institute)
  This fact sheet contains information to help people decide whether the health information they find on the Internet or receive via e-mail from a Web site is likely to be reliable.
• Quackwatch (a private corporation operated by Stephen Barrett, MD)
• Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Analysis)
• The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.
  • The tips include
    • Remember, anyone can publish information on the internet
    • If something sounds too good to be true, it probably is.
    • If the Web site is primarily about selling a product, the information may be worth checking from another source.
    • Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
    • Check to see how current the information is.
    • Check for accuracy. Does the Web site refer to specific studies or organizations?
• The Family Caregiver Alliance has a Web page entitled Evaluating Medical Research Findings and Clinical Trials
  Topics include
  • General Guidelines for Evaluating Medical Research
  • Getting Information from the Web
  • Talking with your Health Care Provider
• …And a Rumor Control site of Note (in addition to Quackwatch)

   

  National Council Against Health Fraud

  National Council Against Health Fraud is a nonprofit health agency fousing on health misinformation, fruad, and quackery as public health problems. Links to publications, position papers and more.

Related articles

• Regulation of alternative medicine: why it doesn’t work, and never can (dcscience.net)
• GlaxoSmithKline Plea – Largest Health Care Fraud Settlement (lawprofessors.typepad.com)
• “What Doctors Don’t Tell You” magazine – reviewed in BMJ and Quackometer (jflahiff.wordpress.com)
• Health care fraud infographic (pathologyblawg.com)
• Dr. Stephen Barrett of Quackwatch Fame Still Needs Help (lizditz.typepad.com)

 

Grasping and even celebrating uncertainty ( How Journalists Can Aid Critical Thinking in Healthcare Decisions) With Resources By Yours Truly

As you regular followers of this blog realize, I champion critical thinking and hope at least some of these blog posts have fostered this approach to selecting what is best for one’s health.
Many of my posts caution against quick fixes, be it fad diets, supplement dependence, or use of potentially harmful complementary medicine substances. To be fair, I have also posted items questioning “Western medicine” practices as when robotic surgery is appropriate.

Gary Schwitzer at HealthNewsReview.org has posted yet another item on how journalists can help us all in healthcare decisions..
Excerpts

Marya Zilberberg posted, “Fast science: No time for uncertainty.”  Excerpt:

“…my anxiety about how we do clinical science overall is not new; this blog is overrun with it. However, the new branch of that anxiety relates to something I have termed “fast science.” Like fast food it fills us up, but the calories are at best empty and at worst detrimental. What I mean is that science is a process more than it is a result, and this process cannot and should not be microwaved….

So, let’s celebrate uncertainty. Let’s take time to question, answer and question again. Slow down, take a deep breath, cook a slow meal and think.”

That’s similar to how I ended my talk at the University of Wisconsin’s event, “Science Writing in the Age of Denial” this week.  I said that:

“Journalists could help people grasp uncertainty and help them apply critical thinking to health care decision-making issues…rather than promote false certainty, shibboleths and non-evidence-based, cheerleading advocacy.”

My talk to University of Wisconsin event, “Science Writing in Age of Denial”

View more PowerPoint from Gary Schwitzer

Related Resources (from my Health/Medical  News & Resources Web site)

• The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.

  The tips include

  • Remember, anyone can publish information on the internet!
  • If something sounds too good to be true, it probably is.
    If the Web site is primarily about selling a product, the information may be worth checking from another source.
  • Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
  • Check to see how current the information is.
  • Check for accuracy. Does the Web site refer to specific studies or organizations?
• The Family Caregiver Alliance has a Web page entitled Evaluating Medical Research Findings and Clinical Trials

Topics include

• General Guidelines for Evaluating Medical Research
• Getting Information from the Web
• Talking with your Health Care Provider

• Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Analysis)
• How to Evaluate Health Information on the Internet (US National Cancer Institute)9iiu9
• Quackwatch (a private corporation operated by Stephen Barrett, MD)

…And a Rumor Control site of Note (in addition to Quackwatch)

National Council Against Health Fraud

National Council Against Health Fraud is a nonprofit health agency fousing on health misinformation, fruad, and quackery as public health problems. Links to publications, position papers and more.

Research prevents eco-fraud

Research prevents eco-fraud

From the 12 December Eureka news alert

In recent years, the growing demand for organic food products has led to the faking of food and fraud. Headed by the Faculty of Science, University of Copenhagen, a European research project will now develop methods capable of both determining the geographical origin of a food product and deciding whether or not it is organic.

Today, many organic food products such as olive oil, coffee and wine are sold at a higher price because of the production methods involved, their special geographical origins or the absence of undesirable compounds.

Recently there have been several instances of falsification and fraud where conventionally grown produce has been sold as organic. This calls for tools capable of tracing the origins and cultivation methods of food products….

….

Great help for food authorities all over Europe

By analysing the chemical composition of fruits and vegetables, the researchers can, among other things, trace differences between conventional and organic growing methods.

In the laboratory, any use of pesticides can be traced and the geographical differences in soil characteristics also leave fingerprints which can be measured on the food by the researchers.

According to the researchers, the analytical tools to be developed by the research project may be used by food authorities at both a national and a European level during the coming years…..

Read the entire press release here

Related articles

• Many Restaurants Fake it as Demand for Organic Food Rises (foodfreedom.wordpress.com)
• Fraud in Organics? (organaholic.com)
• Organic Food Certification – What It ‘Really’ Means to You The Consumer (survivalfarm.wordpress.com)

Don’t Be Fooled By Health Fraud Scams

 

From the FDA site (click here to read entire article)

Red Flags for Fraud:

• CURE ALL! For unrelated diseases
• QUICK FIX! Within days
• ANCIENT REMEDY! Or a secret formula
• REVOLUTIONARY! Or new science
• AMAZING RESULTS! Difficult to verify
• MY TUMOR SHRUNK! Unproven testimonials
• ACT NOW! Limited availability
• LOSE WEIGHT! No diet or exercise
• MONEY-BACK GUARANTEE!

Visit FDA’s Health Fraud Scams Website!

 

 

The science of public health was still in its infancy in the 19th and early 20th centuries when early incarnations of the modern Food and Drug Administration (FDA) tried to protect consumers from “snake oil salesmen” and other shifty characters who swindled the sick and gullible.

Back then the agency was known as the Division, and later the Bureau of Chemistry. Its agents pursued the traveling con men who sold tonics and elixirs—such as “miracle oil” supposedly made from snakes—with promises to cure whatever ails you. Labels did not list ingredients and unsuspecting buyers only found out through bitter experience that they were at best ineffective and at worse deadly.

FDA is still on the case—more than a century later.

The agency has created a new Internet resource to help consumers recognize and protect themselves from the 21st century versions of these bogus health products.

FDA’s Health Fraud Scams website (www.fda.gov/healthfraud) pulls together videos and articles on how to avoid fraudulent schemes, and offers information about products that have been seized, recalled or are the subject of warnings from the agency.

The site also provides links to government resources on health fraud involving FDA-regulated products, such as drugs, dietary supplements, tobacco products, alternative medicines, medical devices, and cosmetics.

Gary Coody, R.Ph., national health fraud coordinator at FDA, calls the site “one-stop shopping” for people who want to learn how to recognize and avoid health fraud scams. Anyone can search the site to see if FDA has taken an action against a product or company. However, just because a product is not listed does not mean that it is legally marketed or safe to use……..

Related articles

• Officials: Several Arrested In Health Care Fraud Ring Bust (newyork.cbslocal.com)
• PCMA — Anti-Fraud Group Spotlights Policies that Promote Health Care Fraud and Abuse (prweb.com)

Academics ‘guest authoring’ ghostwritten medical journal articles should be charged with fraud, legal experts argue

From the 3 August 2011 Medical News Today article

ScienceDaily (Aug. 3, 2011) — Two University of Toronto Faculty of Law professors argue that academics who ‘lend’ their names, and receive substantial credit, as guest authors of medical and scientific articles ghostwritten by industry writers, should be charged with professional and academic misconduct and fraud, even if they contain factually correct information.

In an article published in PLoS Medicine, Professors Simon Stern and Trudo Lemmens argue “Guest authorship is a disturbing violation of academic integrity standards, which form the basis of scientific reliability.” In addition, “The false respectability afforded to claims of safety and effectiveness through the use of academic investigators risks undermining the integrity of biomedical research and patient care.”

In “Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles,” Stern and Lemmens argue that since medical journals, academic institutions, and professional disciplinary bodies have not succeeded in enforcing effective sanctions, a more successful deterrence would be through the imposition of legal liability on the guest authors, “and may give rise to claims that could be pursued in a class action based on the Racketeer Influenced and Corrupt Organizations Act (RICO).”…

Read the entire news article
Journal Reference:
Simon Stern, Trudo Lemmens. Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles. PLoS Medicine, 2011; 8 (8): e1001070 DOI: 10.1371/journal.pmed.1001070

HHS Offers New Tool for Medical School Students to Learn, Detect Medicare Fraud

From a November 8, 2010 US Health and Humans Services (HHS) news release

The Department of Health & Human Service’s Office of Inspector General has released a new tool geared toward educating medical school students on Medicare and Medicaid fraud and abuse laws, according to a news report byThe Hill.

The tool is a booklet, titled “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse,” that will be delivered to medical schools across the country. The booklet covers education on specific fraud and abuse laws and physician relationships with payors, other providers and vendors.

The booklet’s release follows an OIG report that suggested medical school students aren’t adequately trained on healthcare fraud law.

Read The Hill‘s news report about the OIG’s “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse.”

Read other coverage about healthcare fraud reports:

– WSJ: AMA Keeping Data on Physicians and Individual Healthcare Providers Confidential

– Report: Number of Suspected New York Medicaid Fraud Cases Doubled Since Last Year