| Medicare’s inspector general found questionable billings by 2,637 pharmacies participating in the program’s prescription drug benefit. That represents 4 percent of more than 59,000 retail drugstores nationwide. Some metro areas had much higher rates of questionable billings. Here’s a look at those problem areas, percentage of questionable billing and the most common patterns of questionable billings uncovered: | ||
| Area covered Questionable billings percentage Most common patterns of questionable billings uncovered in cities | ||
| National 4.4 | ||
| Miami 19.4 Billed extremely high amount per beneficiary | unusually high share of claims were for brand-name drugs. | |
| Los Angeles 12.1 Billed extremely high amount per beneficiary | extremely high number of prescriptions per prescribing doctor | unusually high share of claims for brand-name drugs. |
| Detroit 10.5 Billed unusually high share of claims for controlled substances. | ||
| Baltimore 9.6 Billed unusually high share of claims for controlled substances. | ||
| New York 9 Billed extremely high amount per beneficiary | unusually high share of claims were for brand-name drugs. | |
| Tampa, Fla. 8.8 Billed unusually high share of claims for controlled substances. |