‘Zombies on Drugs’ Cost Taxpayers Nearly $300,000
Policy + Politics

‘Zombies on Drugs’ Cost Taxpayers Nearly $300,000

If you think zombies have taken over America – “The Walking Dead” gets roughly 17 million viewers per episode – here’s more proof. The Centers for Medicare and Medicaid Services (CMS) paid nearly $300,000 for HIV drugs to go to 158 Medicare part D beneficiaries who are already dead.

A new Inspectors General report puts the tab directly at the aching feet of taxpayers. In some cases, multiple prescriptions were filled for a single dead person.

This may just be the tip of the zombie iceberg, however: The report looked only at one year and only at HIV drugs, “which account for one-quarter of one percent of all Part D drugs in 2012,” the report said.

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Drugs used to treat HIV are expensive and “can be a target for fraud, waste and abuse” – yet “the issues raised are relevant to all Part D drugs,” the report noted. The financial impact across the $85 billion-a-year Medicare prescription program known as Part D was not calculated in the report but clearly could be in the millions or beyond.  

While Medicare has been working to curb prescription drug reimbursements to deceased patients, it clearly “has come up short,” as Government Executive put it, which further explained it this way:  

Because sponsoring pharmacies working with Medicare Part D too often submit payment reports outside the 32-day window following a patient’s death, the Centers for Medicare and Medicaid Services paid for HIV drugs for more than 150 deceased beneficiaries … [The IG,] using prescription drug purchases in 2012 and cross-checking them against the Beneficiary Enrollment Database and the Social Security Administration’s Death Master File, found that Medicare paid for 348 HIV drugs for 158 deceased beneficiaries serviced by 124 pharmacies—at a total cost of $292,381.

Some 37 million Americans use the Medicare Part D system – and earlier reports have shown the federal government to have wasted millions of dollars in reimbursements to people who had already died.

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CMS has an editing system in place that’s supposed to reject records for drugs “with dates of service more than 32 days after death,” the IG report said. Most of the drugs were dispensed by retail pharmacies, the report indicated. “According to CMS, it is possible that – because of delays in receiving death information – it will accept a PDE [prescription drug event] with a date of service that is after the 32-day window,” said the report.

The IG has suggested that CMS either reduce or cut the 32-day window; CMS has agreed.

“After reviewing this report,” wrote administrator Marilyn Tavenner, “CMS has had preliminary discussions with the industry to revisit the need for a 32-day window, which was instituted because the date of service in some pharmacies reflects the date the prescription was filled, not the date the prescription was dispensed.” Discussions are ongoing.

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