OIG is cracking down on fraud and abuse involving HIV drugs

Tuesday, September 16, 2014

OIG is cracking down on fraud and abuse involving HIV drugs which can cost Medicare up to $1,700/month for a single beneficiary. In an August 6, 2014 Podcast, OIG described two schemes involving HIV drugs. In one scheme, people exchanged HIV drug prescriptions for cash or other drugs. Then, a colluding pharmacy would bill the patient’s insurance company, sometimes Medicare or Medicaid, for the HIV drugs without actually filling the prescription. The fraudulent pharmacy also bills for the prescribed refills without actually dispensing the drugs.

In the second scheme, the pharmacy dispenses the HIV drugs to the patient who then sells them to a runner who, in turn, takes the drugs to a fraudulent pharmacy or fraudulent drug wholesaler. The fraudulent pharmacy or wholesaler then either ships the HIV drugs out of the country or sells them to uninsured people in the U.S. In some instances, corrupt pharmacies buy the HIV drugs on the black market and re-package and dispense the drugs to unsuspecting HIV patients.