HHS OIG Data Brief • June 2015 • OEI-02-15-00190. Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D: “More than 1,400 pharmacies had questionable billing for Part D drugs in 2014 A total of 1,432 retail pharmacies billed extremely high amounts for at least one of the five measures we reviewed. A total of 292 pharmacies billed extremely high amounts for multiple measures. Specifically, 283 pharmacies did so for 2 measures, and 9 did so for 3 measures. The measures we reviewed involve the number and types of prescriptions billed, as well as the number of prescribers associated with each beneficiary. Although some of this billing may be legitimate, all pharmacies that bill extremely high amounts warrant further scrutiny.” Key Takeaways: Since 2006, Medicare spending for commonly abused opioids has grown faster than spending for all Part D drugs:

• Pharmacies with questionable billing raise concerns about pharmacy-related fraud schemes
• Geographic hotspots for certain non controlled drugs point to possible fraud and abuse
• These patterns demonstrate that more needs to be done to address fraud and abuse in Part D.”