The Centers for Medicare & Medicaid Services spent $32 million on questionable HIV treatments in 2012, including spending for patients who didn’t even have HIV, according to a new government report released Wednesday.
The Health and Human Services Office of the Inspector General (HHS OIG) found that 1,600 Medicare Part D beneficiaries who received HIV treatment “had no indication of HIV in their Medicare histories, received an excessive dose of or supply of HIV drugs, received HIV drugs from a high number of pharmacies or prescribers, or received contraindicated HIV drugs (i.e., HIV drugs that should not be used in combination with one another).”
$6.5 of the wasted $32 million went to treating patients who hadn’t been diagnosed with HIV, which the OIG astutely pointed out “raises concerns about fraud and abuse.”
Raising concerns that the drugs may have ended up on the black market, the study also explains that the beneficiaries may never even have received the drugs: “the pharmacy could have submitted claims for drugs that were never dispensed, or the beneficiary’s identification number could have been stolen.”
One 77-year-old woman was prescribed $33,536 worth of HIV drugs paid for by Medicare, despite having no indication of HIV in her medical history. “She had prescriptions for 10 different types of HIV drugs prescribed by 6 different doctors. There is no evidence that she visited any of these doctors.” Of the 2,698 prescribers and 2,221 pharmacies implicated, “183 pharmacies and 25 prescribers were previously identified by OIG as having questionable Part D billing.”
Beneficiaries were also prescribed excessive doses and received excessive supplies of HIV medications, with some receiving as much as thirty times the recommended dose and supplies large enough to last for two years. “One beneficiary from New York received a 720-day supply of Norvir 100 mg,” the report explains. “Recent research indicates that when ritonavir—the active ingredient in Norvir—is mixed with some illicit drugs, including ecstasy, it heightens the psychoactive effects of the drugs.”
HHS OIG, an agency “established by law as an independent and objective oversight unit of the Department to carry out the mission of promoting economy, efficiency and effectiveness through the elimination of waste, abuse and fraud,” allocates the majority of its resources toward Medicare and Medicaid investigations.