Medicare Fraud

Insurance fraud affects everyone by making insurance premiums more expensive. PrescribaRx^SM is helping the fight against health care fraud by increasing awareness among our members and employees.

We fully support the prosecution of health care providers, agents, policy owners, employees, and other groups or individuals who defraud the Medicare system and insurance companies. We aggressively investigate reports of fraud and cooperate with law enforcement officials in their prosecution efforts.

Examples of Medicare Plan Fraud

• Billing for prescriptions that were not dispensed
• Dispensing a generic drug, but billing for a brand name drug
• Prescription drug shorting (i.e., billing for 60 tablets, but dispensing 30)
• Bait and switch pricing
• Routine waivers of coinsurance premiums
• Charging a beneficiary a price over the copay amount
• Adding unauthorized refills to a prescriptions
• Drug diversion
• Prescription forging or altering
• Patient has falsely assumed someone’s identity in an attempt to utilize their Medicare benefits

Please view the 2009 Pharmacy Training Fact Sheet and the Universal American’s Medicare Part D Fraud, Waste and Abuse Training for Pharmacies and Pharmacy Staff.

Help Fight Fraud

When someone commits fraud against Medicare, it affects everyone. If you suspect someone of committing insurance fraud against PrescribaRx or think you may be a victim, please report the suspicious activity.

Fraud, Waste and Abuse can be reported by telephone at 1-800-818-0007 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-777-9083) every day, or in writing to:

• PrescribaRx FWA
  29100 Aurora Road
  Solon, OH 44139

All reports are confidential and may be anonymous.

For more information about insurance fraud, visit www.insurancefraud.org.