Date of Award
Thesis (Restricted access)
Implemented January 1, 2006 by the Center for Medicare and Medicaid Services, Medicare’s Prescription Drug Program, also known as Part D, is a voluntary prescription drug program available to all beneficiaries enrolled into Medicare. Though Part D is relatively new, it is one of the highest federal benefit programs with errors. This high error ranking is due to the improper payments within the program. An improper payment is any payment that should not have been made or made in an incorrect amount. In 2013, Part D reached its historical high with $2.1 billion of improper payments out of $57.1 billion in outlays. Although this amounts to 3.7%, the government considers any federal program with improper payments over $750 million within a year high risk.
Improper payments within the Part D program are due to both external causes such as professional provider fraud and internal causes within the Center for Medicare and Medicaid Services such as documentation and verification errors.
Most people believe that our government is not doing much to combat improper spending within Medicare’s Prescription Drug program. There is legislation currently in place to combat this problem such as the False Claims Act which makes knowingly submitting fraudulent claims for payment a criminal offense and more recently, the Affordable Care Act containing new means to fight fraud. Though the current legislation has made good strides, more must be done to prevent, detect, and recover improper payments.
Henry, Melissa, "Medicare D Improper Payments" (2014). Economic Crime Forensics Capstones. Paper 2.