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Part D Pharmacy Enrollment

Since the inception of Part D, numerous OIG reports have raised concerns about Centers for Medicare & Medicaid Services's oversight of or actions to address fraud in the Part D benefit. Recent law enforcement actions have highlighted the role pharmacies can play in prescription drug fraud. When problems occur, Centers for Medicare & Medicaid Services must rely on Part D plan sponsors to follow up and take action against pharmacies. Currently, Part D pharmacies are not required to enroll in Medicare. However, they may enroll for other reasons. For example, pharmacies that bill Medicare for durable medical equipment, prosthetics, orthotics, and supplies under Medicare Part B must enroll in Medicare Fee-for-Service. As a result, Centers for Medicare & Medicaid Services screens these pharmacies to ensure that they meet the requirements to be a Medicare provider. Centers for Medicare & Medicaid Services also has the authority to revoke their enrollment. We will review Centers for Medicare & Medicaid Services's ability to oversee pharmacies that bill for Part D drugs and determine the extent to which pharmacies that bill for Part D drugs, especially those identified as high risk, are enrolled in Medicare Fee-for-Service.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Part D Pharmacy Enrollment Office of Evaluation and Inspections OEI-02-15-00440 2018

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201