FEDS LOOK INTO HOW MARKETERS GET SENIORS’ DATA
An electronic system that pharmacies use to verify Medicare coverage is being scrutinized by the government.
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 that 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 products 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 be crossreferenced 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 frequently were 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.