Report: Suspect billings at 2,600 drugstores

WASHINGTON -- It would take a big pillbox to hold them.

A pharmacy in Kansas billed Medicare for more than 1,000 prescriptions each for two patients in a single year, part of a pattern of questionable billings at 2,600 drugstores nationwide uncovered by federal investigators in a report yesterday.

The inspector general of the Health and Human Services department found that corner drugstores are vulnerable to billion-dollar fraud, partly because Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns.

"While some pharmacies may be billing extremely high amounts for legitimate reasons, all warrant further scrutiny," said the report. Medicare paid $5.6 billion to drugstores whose billings are being questioned.

The analysis broke new ground by scrutinizing every claim submitted by the nation's 59,000 retail pharmacies during 2009 -- nearly 1 billion prescriptions.

Medicare administrator Marilyn Tavenner said the agency mostly agrees with the call to action. But she suggested that requiring private insurers to monitor and report suspicious activity could place a burden on the companies and may flood government officials with leads that turn out to be useless. Medicare said it has anti-fraud contractors that are already keeping close tabs on the program.

"What we are seeing in the data is extremely concerning," said Jodi Nudelman, a regional inspector general in New York who directed the research.

Overall, the inspector general found only a small fraction of retail pharmacies, 4.4 percent, have telltale patterns of questionable billings. New York had 9 percent of pharmacies filing high numbers of questionable claims.