The Associated Press calls it a “quirky bureaucratic rule”, others call it wasteful spending and still others say it’s par for the course for a government that has no clue about budgeting resources – and then they use the $18 trillion national debt as proof. It’s all true. Medicare continues to pay for drugs for the deceased, just as it’s done for decades.
In November, 2014, the Health and Human Services Department’s inspector general released a report that included a Medicare rule that allows payment for prescriptions filled more than a month after the patient has died. It’s like an open wallet, there for the taking, as long as you can beat that 32 day deadline. Obviously, Medicare has a rule (or, at least, we hope it does) that says it won’t pay for drugs that are not medically indicated. Once a person has died, there’s not much indication that the medications will benefit him, yet, that payment policy says otherwise. The Inspector General is strongly encouraging the Centers for Medicare and Medicaid to rethink that policy. Medicare’s response? “We’re working on a fix.”
Drugs for the Deceased
The scope of the investigation was limited to just claims paid in 2012 and for only a few drugs, most of which were used to treat HIV. Turns out, that’s all it took. After cross referencing the prescriptions and the death records, the investigation discovered that the program paid for drugs for 158 beneficiaries after they were already dead. The cost to taxpayers: $292,381, an average of $1,850 for each beneficiary. Remember, this was just for one year, and for less than five drugs. Imagine what an investigation over, say, a five year period and with a larger scope of drugs. The report even mentions that and says it extends much further than just the drugs investigated.
HHS Report Findings
The investigation also found that of 348 HIV prescriptions filled for beneficiaries who were no longer living, nearly half were filled more than a week after the patient died. Sometimes multiple prescriptions were filled on behalf of a single dead person.
The report offers a few examples, as well, which the AP has reported on:
— $1,200 for a prescription for a 90-year-old Boston-area beneficiary that was dispensed 25 days after he died. The man had no history of HIV in his Medicare record. Medicare paid the $1,200, no questions asked.
— In Florida, a pharmacy filled a prescription for an 80-year-old beneficiary more than two weeks after he had passed away. Two HIV drugs, totaling $2,000, were filled. As it filled those prescriptions, the date and time stamps show that it simultaneously filled another prescription for those same two drugs for a woman, who had passed away days earlier. Neither of these recipients were diagnosed with HIV.
No one knows where the drugs went; however, it’s believed they were actually used for patients who indeed have HIV but who cannot afford the drugs that keep them alive. Turns out, there’s big demand for these drugs with few avenues for those in need to get to them.
It’s understandable in many ways, but it doesn’t negate the reality that our healthcare system isn’t as “fixed” as many may believe. It’s also indicative of the importance of those without Medicaid or Medicare to seek out help for coverage. It’s available. To learn more about qualifying for Medicaid or Medicare, contact our offices today.