Reducing Pharmacy Fraud in Medicare Part D

OBJECTIVE

OIG has longstanding concerns about fraud committed by bad-actor pharmacies. This fraud puts the Part D program and millions of taxpayer dollars at risk every year. Key tools that CMS uses to safeguard other parts of Medicare from fraud, such as revocation, preclusion, and payment suspension, may not be effective at deterring fraud by pharmacies that bill Part D plan sponsors. This review will determine the extent to which pharmacies that have been identified as bad actors by CMS or Part D plan sponsors continue to bill and receive payment for drugs under Part D. This review will seek to describe and identify opportunities for CMS and Part D plan sponsors to improve their ability to detect and reduce potential fraud by pharmacies in the Part D program.

TIMELINE

• January 15, 2026
  Announced
• Today
  Office of Evaluation and Inspections In-Progress
• Est FY2028
  Estimated Fiscal Year for Project Completion

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