sunny.png
Thursday December 3rd, 2020 11:39AM

Feds probing how personal Medicare info gets to marketers

By The Associated Press
Related Articles
  Contact Editor

WASHINGTON (AP) — A government watchdog is launching a nationwide probe into how marketers may be getting seniors’ personal Medicare information aided by apparent misuse of a government system, officials said Friday.

The audit will be formally announced next week said Tesia Williams, a spokeswoman for the Health and Human Services inspector general's office. It follows a narrower probe which found that an electronic system for pharmacies to verify Medicare coverage was being used for potentially inappropriate searchers seemingly tied to marketing. It raised red flags about possible fraud.

The watchdog agency's decision comes amid a wave of relentlessly efficient telemarketing scams targeting Medicare recipients and involving everything from back braces to DNA cheek swabs.

For years, seniors have been admonished not to give out their Medicare information to people they don't know. But a report on the inspector general's initial probe,also released Friday, details how sensitive details can still get to marketers. It can happen even when a Medicare beneficiary thinks he or she is dealing with a trustworthy entity such as a pharmacy or doctor's office.

Key personal details gleaned from Medicare's files can then be cross-referenced with databases of individual phone numbers, allowing marketers to home in with their calls.

The initial audit focused on 30 pharmacies and other service providers that were frequently pinging a Medicare system created for drugstores.

The electronic system is intended to be used for verifying a senior's eligibility at the sales counter. It can validate coverage and personal details on millions of individuals. Analyzing records that covered 2013-15, investigators discovered that most of the audited pharmacies, along with a software company and a drug compounding service also scrutinized, weren't necessarily filling prescriptions.

Instead, they appeared to have been tapping into the system for potentially inappropriate marketing.

Medicare stipulates that the electronic queries — termed “E1 transactions”— are supposed to be used to bill for prescriptions. But investigators found that some pharmacies submitted tens of thousands of queries that could not be matched to prescriptions. In one case, a pharmacy submitted 181,963 such queries but only 41 could be linked to prescriptions.

The report found that on average 98% of the electronic queries from 25 service providers in the initial audit “were not associated with a prescription.” The inspector general's office did not identify the pharmacies and service providers.

Pharmacies are able to access coverage data on Medicare recipients by using a special provider number from the government.

But investigators found that four of the pharmacies they audited allowed marketing companies to use their provider numbers to ping Medicare. “This practice of granting telemarketers access to E1 transactions, or using E1 transactions for marketing purposes puts the privacy of the beneficiaries' (personal information) at risk,” the report said.

Some pharmacies also used seniors' information to contact doctors treating those beneficiaries to see if they would write prescriptions. Citing an example, the report said, “The doctor often informed (one) provider that the beneficiary did not need the medication.”

The inspector general's office said it is investigating several health care providers for alleged fraud involving E1 transactions. Inappropriate use of Medicare's eligibility system is probably just one of many paths through which telemarketers and other sales outfits can get sensitive personal information about beneficiaries, investigators said.

A group representing independent drugstores expressed support for the investigation. “It's about time,” said Douglas Hoey, CEO of the National Community Pharmacists Association. “We welcome the effort to clean up this misbehavior.” Hoey said some local pharmacists have complained of what appear to be sophisticated schemes to poach customers who take high-cost drugs.

The watchdog agency began looking into the matter after the Centers for Medicare and Medicaid Services, or CMS, asked for an audit of a mail order pharmacy's use of Medicare's eligibility verification system.

In a formal response to the report, CMS Administrator Seema Verma said CMS retooled its verification system last year so it automatically kicks out queries that aren't coming from a pharmacy. More than a quarter-million such requests have been rejected, she wrote.

Medicare is committed to ensuring that the system is used appropriately, Verma added. The agency can revoke access for pharmacies that misuse the privilege and is exploring other enforcement options.

The inspector general's office acknowledged Medicare's countermeasures but said it wants to see how effective they've been.

Health care fraud is a pervasive problem that costs taxpayers tens of billions of dollars a year. Its true extent is unknown, and some cases involve gray areas of complex payment policies.

In recent years, Medicare has gotten more sophisticated, adapting techniques used by financial companies to try to head off fraud. Law enforcement coordination has grown, with strike forces of federal prosecutors and agents, along with state counterparts, specializing in health care investigations.

Officials gave no timetable for completing the audit.

  • Associated Categories: U.S. News, Associated Press (AP), AP National News, Top U.S. News short headlines, AP Online Headlines - Washington, AP Health, AP Business, AP Business - Corporate News, AP Business - Personal Finance
© Copyright 2020 AccessWDUN.com
All rights reserved. This material may not be published, broadcast, rewritten, or redistributed without permission.
Feds probing how personal Medicare info gets to marketers
A government watchdog says it's launching a probe of how telemarketers may be getting hold of seniors’ personal Medicare information, aided by apparent misuse of a government system
12:45PM ( 8 minutes ago )
Amid coronavirus fears, a second wave of flu hits US kids
A second wave of flu is hitting the U.S., turning this into one of the nastiest seasons for children in a decade
12:43PM ( 10 minutes ago )
Facebook reverses on paid influencers after Bloomberg memes
Facebook has decided to allow a type of paid political message that had sidestepped many of the social network's rules governing political ads
12:43PM ( 11 minutes ago )
Associated Press (AP)
Trump ignores AG Barr's request to stop tweeting about DOJ
President Donald Trump is ignoring his attorney general's public request to stop tweeting about the Justice Department
12:12PM ( 41 minutes ago )
Valentine's Day brings love and some worry in Iraq holy city
This Valentine’s season, Hasanain al-Rufaye is busy in his Najaf, Iraq, flower shop, wrapping bouquets and stuffing dolls into gift boxes
12:06PM ( 48 minutes ago )
Official says US, Taliban reach Afghanistan truce agreement
A senior U.S. official says the United States and the Taliban have reached a truce agreement that will take effect “very soon” and could lead to withdrawals of American troops from Afghanistan
12:05PM ( 49 minutes ago )
AP National News
Prosecutors get final word at Harvey Weinstein’s rape trial
Prosecutors are giving their closing argument Friday at Harvey Weinstein’s rape trial
5:52AM ( 7 hours ago )
Prepping straw bedding for dogs signals Iditarod is near
Volunteers slinging bales of hay signaled the first volunteer event for this year's Iditarod Trail Sled Dog Race
4:38AM ( 8 hours ago )
In 2 years, Florida 'red flag' law removes hundreds of guns
A Florida law that allows judges to bar anyone deemed dangerous from possessing firearms has been used 3,500 times since its enactment after a 2018 high school massacre
1:50AM ( 11 hours ago )
Top U.S. News short headlines
Official says US, Taliban reach truce Afghan truce agreement
A senior U.S.official says the United States and the Taliban have reached a truce agreement that will take effect “very soon” and could lead to withdrawals of American troops from Afghanistan
11:25AM ( 1 hour ago )
EU chief unveils budget plan setting scene for tense summit
A top European Union official unveiled Friday his proposal for the bloc's next long-term budget
11:16AM ( 1 hour ago )
Pompeo, Esper meet Afghan president on cusp of Taliban deal
U.S. Secretary of State Mike Pompeo and Defense Secretary Mark Esper have met with Afghanistan's President Ashraf Ghani amid signs a truce between the United States and the Taliban is imminent
10:36AM ( 2 hours ago )
AP Online Headlines - Washington
US stocks edge higher in midday, head for weekly gains
U.S. stocks edged higher in midday trading Friday as investors focused on another round of mostly solid corporate earnings
11:55AM ( 59 minutes ago )
Cruise stranded by virus fears ends with roses in Cambodia
Hundreds of cruise ship passengers long stranded at sea by virus fears have finally disembarked in Cambodia, where they were welcomed by the nation's authoritarian leader who handed them flowers
11:05AM ( 1 hour ago )
Negative interest rates turn saving, borrowing upside down
These are strange times for borrowers and savers
10:59AM ( 1 hour ago )
AP Business
US manufacturing output hit by Boeing troubles, slips 0.1%
U.S. manufacturing output fell slightly in January, driven lower by Boeing's decision to halt production of its troubled 737 MAX aircraft
9:20AM ( 3 hours ago )
German economy stagnates in sign of Europe's difficulties
Germany’s economy stagnated at the end of the year with zero growth in the fourth quarter
5:47AM ( 7 hours ago )
Renault sales and earnings drop in tough market
French carmaker Renault saw its sales and earnings drop last year
5:35AM ( 7 hours ago )
AP Business - Corporate News
Buyers face more competition amid shortage of home listings
Americans shopping for a home this spring may face more competition than they have in years
2:01PM ( 22 hours ago )
US mortgages flat to slightly higher; 30-year loan at 3.47%
U.S. long-term mortgage rates were flat to slightly higher this week after three straight weeks of declines, as the historically low levels continue as an incentive for potential homebuyers
12:27PM ( 1 day ago )
401(k)s hit records as workers sock away more, stocks jump
Fidelity Investments says the average 401(k) balance rose to a record $112,300 last year
11:04AM ( 1 day ago )
AP Business - Personal Finance
Amid coronavirus fears, a second wave of flu hits US kids
A second wave of flu is hitting the U.S., turning this into one of the nastiest seasons for children in a decade
12:43PM ( 10 minutes ago )
Facebook reverses on paid influencers after Bloomberg memes
Facebook has decided to allow a type of paid political message that had sidestepped many of the social network's rules governing political ads
12:43PM ( 11 minutes ago )
Prosecutor: Weinstein saw victims as 'complete disposables'
Prosecutors began their closing argument Friday at Harvey Weinstein’s rape trial by saying he believed he was so powerful he could get away with denigrating aspiring actresses drawn into a world where he considered them “complete disposables
12:43PM ( 11 minutes ago )
US appeals panel upholds block of Medicaid work requirements
A federal appeals court panel in Washington has upheld a lower court's decision that blocked the Trump administration's work requirements for Medicaid recipients
12:41PM ( 12 minutes ago )
US closes case against ex-FBI boss McCabe with no charges
Federal prosecutors have declined to charge former FBI Deputy Director Andrew McCabe, closing an investigation into whether he lied to federal officials about his involvement in a news media disclosure
12:38PM ( 15 minutes ago )