Pharmacy and Prescription Drug Fraud

Medicare drug coverage (Part D) helps cover the cost of prescription drugs; some prescriptions are also covered under Part B. Pharmacy and prescription drug fraud schemes can happen in both. A common scheme is if someone’s Medicare plan was billed for a medication that was not received, or if they were given a different drug than the medical provider ordered.

Report potential pharmacy or prescription drug fraud, errors, or abuse if you:

• See on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for:
  • Drugs, including refills, that were never picked up, sent, or even prescribed
  • Drugs (sometimes controlled drugs such as opioids) that were prescribed by a doctor you have never seen
  • More drugs than the amount you were prescribed
  • A different drug, often one that costs more, than the one you were first prescribed or a drug that may not be approved by the U.S. Food and Drug Administration (FDA)
• Were purposely given less medication than you were prescribed, or you were given expired prescription drugs
• Were given and billed for a costly compounded drug, such as pain cream, when a lower-cost prescription was ordered by your doctor
• Were offered “free” or “discount” prescription drugs without an order from your doctor and Medicare was billed
• Were offered by a pharmacy gift cards or other payment, to switch your prescription drugs over to their pharmacy
• Were offered money for the use of your Medicare number to bill for prescription drugs

Caregivers and family members, be on the lookout for: 

• The number of prescribed pills does not match the number your loved one received
• Your loved one received gift cards, money, or discounts to switch to a different pharmacy
• Your loved one had their prescription drugs being automatically refilled when they didn’t need or want them

Watch this video to learn how to read your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB).

Report Suspected Fraud

To report suspected fraud, click here.