jurisdiction: US

text: b"Department of Health and Human Services\n\n OFFICE OF \n\n INSPECTOR GENERAL \n\n\n\n\n\n MEDICARE DRUG PLAN \n\n SPONSORS\xe2\x80\x99 IDENTIFICATION OF \n\n POTENTIAL FRAUD AND ABUSE\n\n\n\n\n\n Daniel R. Levinson\n\n Inspector General \n\n\n October 2008\n\n OEI-03-07-00380\n\n\x0c Office of Inspector General\n\n http://oig.hhs.gov\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as\namended, is to protect the integrity of the Department of Health and Human Services\n(HHS) programs, as well as the health and welfare of beneficiaries served by those\nprograms. This statutory mission is carried out through a nationwide network of audits,\ninvestigations, and inspections conducted by the following operating components:\n\nOffice of Audit Services\nThe Office of Audit Services (OAS) provides auditing services for HHS, either by conducting\naudits with its own audit resources or by overseeing audit work done by others. Audits\nexamine the performance of HHS programs and/or its grantees and contractors in carrying\nout their respective responsibilities and are intended to provide independent assessments of\nHHS programs and operations. These assessments help reduce waste, abuse, and\nmismanagement and promote economy and efficiency throughout HHS.\n\nOffice of Evaluation and Inspections\nThe Office of Evaluation and Inspections (OEI) conducts national evaluations to provide\nHHS, Congress, and the public with timely, useful, and reliable information on significant\nissues. These evaluations focus on preventing fraud, waste, or abuse and promoting\neconomy, efficiency, and effectiveness of departmental programs. To promote impact, OEI\nreports also present practical recommendations for improving program operations.\n\nOffice of Investigations\nThe Office of Investigations (OI) conducts criminal, civil, and administrative investigations\nof fraud and misconduct related to HHS programs, operations, and beneficiaries. With\ninvestigators working in all 50 States and the District of Columbia, OI utilizes its resources\nby actively coordinating with the Department of Justice and other Federal, State, and local\nlaw enforcement authorities. The investigative efforts of OI often lead to criminal\nconvictions, administrative sanctions, and/or civil monetary penalties.\n\nOffice of Counsel to the Inspector General\nThe Office of Counsel to the Inspector General (OCIG) provides general legal services to\nOIG, rendering advice and opinions on HHS programs and operations and providing all\nlegal support for OIG\xe2\x80\x99s internal operations. OCIG represents OIG in all civil and\nadministrative fraud and abuse cases involving HHS programs, including False Claims Act,\nprogram exclusion, and civil monetary penalty cases. In connection with these cases, OCIG\nalso negotiates and monitors corporate integrity agreements. OCIG renders advisory\nopinions, issues compliance program guidance, publishes fraud alerts, and provides other\nguidance to the health care industry concerning the anti-kickback statute and other OIG\nenforcement authorities.\n\x0c\xce\x94 E X E C U T I V E S U M M A R Y\n\n\n OBJECTIVES\n To determine:\n\n 1. the extent to which Medicare stand-alone prescription drug plan\n sponsors identified potential fraud and abuse;\n\n 2. the type of potential fraud and abuse that these plan sponsors\n identified; and\n\n 3. the extent to which these plan sponsors conducted inquiries, initiated\n corrective actions, and made referrals for further investigation\n regarding potential fraud and abuse.\n\n\n BACKGROUND\n As of January 1, 2006, Medicare beneficiaries could obtain prescription\n drug coverage under the Medicare Part D program. Part D\n expenditures for 2007 were approximately $49.5 billion. As of August\n 2008, 26 million beneficiaries were enrolled in Part D and two-thirds\n were in stand-alone drug plans.\n\n Plan sponsors are private companies that contract with the Centers for\n Medicare & Medicaid Services (CMS) to provide Part D drug coverage to\n Medicare beneficiaries. Sponsors are required to have a comprehensive\n program to detect and deter fraud and abuse. They can identify\n potential fraud and abuse through internal efforts such as claim\n reviews, and through complaints or referrals from external sources such\n as CMS, Medicare Drug Integrity Contractors (MEDIC), law\n enforcement agencies, beneficiaries, and pharmacy providers.\n\n Upon identifying potential fraud and abuse, sponsors are required to\n conduct an inquiry and initiate appropriate corrective action. CMS\n recommends that sponsors refer potential fraud and abuse incidents to\n MEDICs and/or law enforcement agencies.\n\n The only type of fraud and abuse information CMS requires sponsors to\n report to CMS is the aggregate number of fraud and abuse complaints\n they received directly from beneficiaries each quarter.\n\n We analyzed data representing the first 6 months of 2007 from\n 86 of 91 stand-alone drug plan sponsors. We did not include\n 5 of the 91 plan sponsors because 1 had been terminated from the\n program, 1 was under investigation, and the other 3 did not provide\n data in time to be included in our review.\n\nOEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE i\n\x0cE X E C U T I V E S U M M A R Y \n\n\n\n\n FINDINGS\n Overall, 24 of 86 Part D stand-alone plan sponsors did not identify\n any potential fraud and abuse incidents; most potential fraud and\n abuse incidents were associated with only a small number of plan\n sponsors. Twenty-four plan sponsors (28 percent) did not identify any\n potential fraud and abuse incidents in the first 6 months of 2007 either\n from internal efforts or complaints from external sources. Of the\n 62 plan sponsors that identified a total of 9,774 incidents of potential\n fraud and abuse during this period, 7 plan sponsors accounted for\n 90 percent of all incidents. One of the seven plan sponsors identified\n 67 percent of all incidents.\n Plan sponsors identified 78 percent of all potential fraud and abuse\n incidents through internal efforts; however, 42 plan sponsors did not\n identify any potential fraud and abuse through internal efforts. One\n plan sponsor was associated with 84 percent of the potential fraud and\n abuse identified through internal efforts.\n\n Twenty-two percent of potential fraud and abuse incidents identified\n came from external sources; however, 34 plan sponsors did not identify\n any potential fraud and abuse incidents from external sources. Two\n plan sponsors had the majority (51 percent) of these incidents.\n Inappropriate billing was the most prevalent type of potential fraud\n and abuse incident identified, and pharmacies were associated with\n most of the potential fraud and abuse incidents. Plan sponsors\n identified 26 different types of fraud and abuse (both from internal\n efforts and complaints from external sources). Of the 26 types, the most\n prevalent type was inappropriate billing, which accounted for 9,073\n incidents. An example of inappropriate billing is submitting claims for\n drugs not provided.\n\n Plan sponsors identified 11 types of persons or entities associated with\n potential fraud and abuse. Pharmacies/pharmacists were most often\n associated with these incidents.\n Not all 62 plan sponsors that identified potential fraud and abuse\n incidents conducted inquiries, initiated corrective actions, or made\n referrals for further investigation. Three actions that plan sponsors\n can take after identifying potential fraud and abuse are conducting\n inquiries, initiating corrective actions, and referring incidents for\n further investigation. Of the 62 plan sponsors that identified incidents\n of potential fraud and abuse, 47 conducted inquiries, 32 initiated\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE ii\n\x0cE X E C U T I V E S U M M A R Y\n\n\n corrective actions, and 33 referred incidents to other entities for further\n investigation. Overall, 17 plan sponsors initiated all three actions,\n 21 initiated two actions, 19 initiated one action, and 5 did not initiate\n any of these actions.\n\n\n RECOMMENDATIONS\n Plan sponsors are the first line of defense against Part D fraud and\n abuse. However, we found that some plan sponsors did not identify any\n potential fraud and abuse incidents. Moreover, some of the plan\n sponsors that identified potential fraud and abuse incidents did not\n initiate inquiries, corrective actions, or referrals.\n CMS does not routinely collect information that would describe the\n overall volume or types of Part D fraud and abuse that occur or that\n would inform CMS as to the effectiveness of the comprehensive fraud\n and abuse plan each sponsor is required to have in place. The only\n information that CMS requires plan sponsors to report to CMS\n concerning fraud and abuse is the quarterly aggregate number of fraud\n and abuse complaints that plan sponsors receive from beneficiaries.\n\n A crucial aspect of protecting the integrity of the Part D program is\n ensuring that the plan sponsors have a comprehensive and effective\n program to detect and deter fraud and abuse. Therefore, we recommend\n that CMS:\n Review Part D plan sponsors to determine why certain sponsors\n have identified especially high or low volumes of potential fraud and\n abuse incidents.\n Determine whether the Part D plan sponsors that identified potential\n fraud and abuse initiated inquiries and corrective actions as\n required by CMS, and made referrals for further investigation as\n recommended by CMS.\n Require Part D plan sponsors to maintain and routinely report\n information related to the results of sponsors\xe2\x80\x99 fraud and abuse\n programs.\n Use this required information to help determine the effectiveness of\n sponsors\xe2\x80\x99 fraud and abuse programs.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE iii\n\x0cE X E C U T I V E S U M M A R Y \n\n\n\n\n AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL\n RESPONSE\n CMS stated that it is committed to combating fraud, waste, and abuse\n in the Part D program but that because of limited funding, it has not\n been able to perform as much direct oversight of the Part D sponsors\xe2\x80\x99\n fraud, waste, and abuse efforts as expected.\n\n In response to OIG\xe2\x80\x99s first recommendation, CMS stated that it agreed\n that the variability in the number of potential fraud and abuse incidents\n identified by sponsors is a concern and that CMS will examine the data\n more closely by referring the findings to MEDICs. CMS also stated that\n it intends to revise the reporting requirements and give sponsors more\n specific guidance on how to track and properly label incidents, e.g., as\n an education issue or a potential fraud issue.\n\n CMS concurred with OIG\xe2\x80\x99s second recommendation and will refer the\n data in this report to MEDICs for further investigation.\n\n Although CMS provided comments about OIG\xe2\x80\x99s third recommendation,\n CMS did not state whether it concurred. CMS did state that OIG\xe2\x80\x99s\n report would be useful when CMS initiates its Part D sponsor\n compliance plan audits. CMS stated that our report will help ensure\n that sponsors are conducting their own internal investigations and\n taking appropriate corrective actions. CMS did not address OIG\xe2\x80\x99s\n fourth recommendation.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE iv\n\x0c\xce\x94 T A B L E O F C O N T E N T S\n\n\n\n EXECUTIVE SUMMARY .....................................i\n\n\n\n\n INTRODUCTION ........................................... 1\n\n\n\n\n FINDINGS ................................................. 8\n\n Some plan sponsors did not identify any potential \n\n fraud and abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 \n\n\n Inappropriate billing was most prevalent type of potential \n\n fraud and abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 \n\n\n Not all plan sponsors with potential fraud and abuse \n\n initiated inquiries, corrective actions, or referrals . . . . . . . . . . . . 11 \n\n\n\n\n R E C O M M E N D A T I O N S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 \n\n Agency Comments and Office of Inspector General Response . . . 15 \n\n\n\n A P P E N D I X E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 \n\n A:\t Selected Fraud and Abuse Activities for Stand-Alone \n\n Drug Plan Sponsors, First 6 Months of 2007 . . . . . . . . . . . . . . 17 \n\n\n B: \tTypes of Potential Fraud and Abuse Identified by \n\n Stand-Alone Drug Plan Sponsors, First 6 Months of 2007 . . 20 \n\n\n C: \tAgency Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 \n\n\n\n A C K N O W L E D G M E N T S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 \n\n\x0cI N T R O D U C T I O N\n\xce\x94 I N T R O D U C T I O N\n\n\n OBJECTIVES\n To determine:\n\n 1. the extent to which Medicare stand-alone prescription drug plan\n sponsors identified potential fraud and abuse;\n\n 2. the type of potential fraud and abuse that these plan sponsors\n identified; and\n\n 3. the extent to which these plan sponsors conducted inquiries,\n initiated corrective actions, and made referrals for further\n investigation regarding potential fraud and abuse.\n\n\n BACKGROUND\n As of January 1, 2006, Medicare beneficiaries could obtain prescription\n drug coverage under the Medicare Part D program (hereinafter\n Part D). 1 Part D expenditures for 2007 were approximately\n $49.5 billion. 2\n Stand-Alone Drug Plan Coverage\n Stand-alone drug plan coverage refers to a plan for prescription drugs\n only. Beneficiaries who enroll in Part D have the option to receive their\n drug coverage from a stand-alone drug plan sponsor or a managed-care\n plan sponsor that covers other medical benefits in addition to\n prescription drugs.\n\n Two-thirds of the 26 million beneficiaries enrolled in Part D as of\n August 2008 were enrolled in plans offered by stand-alone plan\n sponsors. 3\n Prescription Drug Plan Sponsors\n Prescription drug plan sponsors (plan sponsors) are private companies\n that provide Part D drug coverage to Medicare beneficiaries. The\n Centers for Medicare & Medicaid Services (CMS) makes monthly\n prospective payments to sponsors for each of the beneficiaries covered\n\n 1 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 \xc2\xa7 101;\n P.L. No. 108-173 \xc2\xa7 101; Social Security Act, \xc2\xa7 1860D-1(a)(2); 42 U.S.C. \xc2\xa7 1395w-101(a)(2).\n 2 The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary\n Medical Insurance Trust Funds, \xe2\x80\x9c2008 Annual Report,\xe2\x80\x9d p. 111. Available online at\n http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2008.pdf. Accessed on\n April 22, 2008.\n 3 CMS, \xe2\x80\x9cMonthly Contract and Enrollment Summary Report.\xe2\x80\x9d Available online at\n http://www.cms.hhs.gov/MCRAdvPartDEnrolData/. Accessed on September 29, 2008.\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 1\n\x0cI N T R O D U C T I O N\n\n\n by the sponsors\xe2\x80\x99 plans. The payments are based on estimates that\n sponsors provide in their approved bids prior to the beginning of the\n plan year. Sponsors\xe2\x80\x99 bids are based on their actual costs from the base\n year. After the close of the plan year, CMS must reconcile the payments\n with the sponsors\xe2\x80\x99 actual costs to determine whether sponsors owe\n money to Medicare or Medicare owes money to sponsors based on\n legislatively mandated risk-sharing percentages. 4 Thus, under Part D,\n both Medicare and sponsors share the profits and losses of providing the\n benefit.\n\n CMS contracts with plan sponsors to provide drug plans in designated\n regions. CMS established 39 stand-alone drug plan regions in 2007. Of\n the 39 regions, 25 included one State each, 9 included multiple States,\n and the remaining 5 included one U.S. territory each. Plan sponsors\n may offer plans in one or more regions and may offer plans with\n different features within each region. Plan sponsors may also offer\n plans to employer/union groups.\n\n Plan sponsors may use related entities and subcontractors to fulfill their\n Part D contract. A related entity is a company that is related to the\n plan sponsor by common ownership or control. The subcontractors of\n plan sponsors may also subcontract. 5 For example, a plan sponsor\n might subcontract with a pharmacy benefit manager (PBM), and the\n PBM might subcontract with numerous pharmacies. Regardless of the\n number of subcontractors and related entities involved per plan\n sponsor, the plan sponsor is ultimately responsible for the Medicare\n contract requirements and all data submitted to CMS. 6\n Detecting and Deterring Fraud and Abuse\n Plan sponsors are required to have a comprehensive program to detect\n and deter fraud and abuse. 7 The specifics of the program are left to the\n discretion of each plan sponsor. However, CMS provides fraud and\n abuse program guidelines for plan sponsors in chapter 9 of its\n \xe2\x80\x9cPrescription Drug Benefit Manual\xe2\x80\x9d (hereinafter CMS Manual).\n\n Fraud and abuse reporting. CMS does not require plan sponsors to\n report statistics about fraud and abuse detection and deterrence other\n\n 4 42 U.S.C. \xc2\xa7 1395w-115e. \n\n 5 CMS refers to the subcontractors as first tier and downstream entities. CMS, \n\n \xe2\x80\x9cPrescription Drug Benefit Manual,\xe2\x80\x9d v. 4-25-06, ch. 9, \xc2\xa7 40.\n 6 42 CFR \xc2\xa7\xc2\xa7 423.505(i) and 423.505(k).\n 7 42 CFR \xc2\xa7 423.504(b)(4)(vi)(H).\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 2\n\x0cI N T R O D U C T I O N\n\n\n than the quarterly aggregate number of fraud and abuse complaints\n that plan sponsors receive from beneficiaries. The requirement to\n report complaints is based on a Federal regulation that requires plan\n sponsors to keep track of enrollee grievances. 8 CMS uses the term\n \xe2\x80\x9cgrievance\xe2\x80\x9d for beneficiary complaints to sponsors to distinguish them\n from beneficiary complaints that CMS receives from its complaint\n lines. 9 We will use the term \xe2\x80\x9ccomplaints from beneficiaries\xe2\x80\x9d or\n \xe2\x80\x9cbeneficiary complaints\xe2\x80\x9d to refer to grievances in this report. Fraud and\n abuse is one of 11 categories of beneficiary complaints that plan\n sponsors report to CMS.\n\n Plan sponsors must report to CMS the number of beneficiary complaints\n they receive for each plan. CMS\xe2\x80\x99s instructions state that because plan\n sponsors must maintain certain information about the enrollee\n regarding each complaint, plan sponsors should be able to report the\n data by plan. 10\n CMS defines fraud and abuse complaints as follows:\n\n \xe2\x80\xa2\t A fraud complaint is an allegation that a person or an entity\n (e.g., beneficiary, provider, or plan) engaged in an intentional\n deception or misrepresentation that they know or believe to be\n false and that they know could result in some unauthorized\n benefits.\n\n \xe2\x80\xa2\t An abuse complaint is an allegation that a person or an entity\n (e.g., beneficiary, provider, or plan) engaged in behavior that they\n should have known to be false and that could result in some\n unauthorized benefits.\n\n Internal and external sources of information about potential fraud and\n abuse. Plan sponsors can identify potential fraud and abuse through\n internal efforts, such as claim reviews and subcontractor audits. 11\n Plan sponsors can also identify potential fraud and abuse through\n complaints they receive from external sources. External sources include\n\n\n\n\n 8 42 CFR \xc2\xa7 423.564(g).\n 9 CMS, \xe2\x80\x9cCY 2007 Part D Reporting Requirements: Frequently Asked Questions.\xe2\x80\x9d \n\n 10 Ibid. \n\n 11 CMS, \xe2\x80\x9cPrescription Drug Benefit Manual,\xe2\x80\x9d v. 4-25-06, ch. 9, \xc2\xa7\xc2\xa7 50.2.6.1\xe2\x80\x9350.2.6.3.\n\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 3\n\x0cI N T R O D U C T I O N \n\n\n\n\n\n CMS, Medicare Drug Integrity Contractors (MEDIC), law enforcement\n agencies, beneficiaries, and pharmacy providers.\n\n In this report, when we use the phrase \xe2\x80\x9ccomplaints from external\n sources,\xe2\x80\x9d we mean all fraud and abuse complaints or referrals made to\n plan sponsors, including those from beneficiaries.\n\n Inquiries into potential fraud and abuse. Plan sponsors are required to\n conduct a timely, reasonable inquiry (i.e., preliminary investigation)\n when evidence suggests potential fraud or abuse related to payment or\n delivery of Part D prescription drug items or services. 12 CMS\n recommends that the inquiry be initiated no later than 2 weeks from\n the date the incident is identified. In the event that the plan sponsor\n does not have time or resources to investigate the incident, CMS\n recommends that plan sponsors refer the incident to a MEDIC within\n 2 weeks from the date the incident is identified. MEDICs will further\n investigate referrals from plan sponsors and make referrals to law\n enforcement agencies when necessary. 13 MEDICs are responsible for\n assisting CMS with Part D audits, oversight, and antifraud and abuse\n efforts.\n\n Corrective actions. In response to potential fraud and abuse, plan\n sponsors are required to carry out appropriate corrective actions\n (e.g., repayment of overpayments and disciplinary action against\n responsible individuals). 14\n Referrals to Government entities for further investigation. CMS\n recommends that after conducting inquiries, if plan sponsors identify\n potential fraud or abuse, they should refer the incidents to a MEDIC for\n further investigation. CMS recommends that the referral be made\n within 2 months of determining that fraud or abuse may have\n occurred. 15\n CMS also recommends that plan sponsors voluntarily report potential\n fraud or abuse discovered at the level of the plans, subcontractors, or\n sponsor-related entities to law enforcement entities, such as the Office\n\n\n\n 12 42 CFR \xc2\xa7 423.504(b)(4)(vi)(G)(1). \n\n 13 CMS, \xe2\x80\x9cPrescription Drug Benefit Manual,\xe2\x80\x9d v. 4-25-06, ch. 9, \xc2\xa7 50.2.8.3. \n\n 14 42 CFR \xc2\xa7 423.504(b)(4)(vi)(G)(2). \n\n 15 CMS, \xe2\x80\x9cPrescription Drug Benefit Manual,\xe2\x80\x9d v. 4-25-06, ch. 9, \xc2\xa7 50.2.8.2. \n\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 4\n\x0cI N T R O D U C T I O N\n\n\n of Inspector General (OIG) (through OIG\xe2\x80\x99s Provider Self-Disclosure\n Protocol) or the Department of Justice. 16 17\n Plan sponsors can also make referrals for further investigation to other\n Government entities, including CMS, State agencies, and local law\n enforcement agencies.\n Related Study by the Office of Inspector General\n In December 2006, OIG issued a report entitled \xe2\x80\x9cPrescription Drug Plan\n Sponsors\xe2\x80\x99 Compliance Plans\xe2\x80\x9d (OEI-03-06-00100). In this study, OIG\n found that of 79 compliance plans for stand-alone drug plan sponsors:\n\n \xe2\x80\xa2\t 14 did not indicate that the sponsors had any procedures in\n place to identify fraud and abuse;\n\n \xe2\x80\xa2\t 19 did not indicate that the sponsors had procedures to\n voluntarily report fraud or misconduct to Government entities,\n such as OIG or the Department of Justice;\n\n \xe2\x80\xa2\t 43 did not describe procedures for responding to compliance\n violations; and\n\n \xe2\x80\xa2\t 54 did not provide detailed descriptions of the types of corrective\n actions sponsors undertake in response to compliance violations.\n\n\n METHODOLOGY\n Scope\n We reviewed Medicare Part D stand-alone drug plan sponsors\xe2\x80\x99 fraud\n and abuse information for the first 6 months of 2007. During this\n period, there were 91 such plan sponsors across the country and in U.S.\n territories. However, our study includes 86 plan sponsors with a total of\n 2,039 plans. 18 We did not include five plan sponsors because one had\n\n\n 16 Ibid. In December 2007, CMS issued a final rule retaining plan sponsors\xe2\x80\x99 voluntary\n self-reporting of potential fraud or misconduct. However, in the publication of the rule,\n CMS stated that it is committed to adopting mandatory self-reporting and was seeking\n additional comments to craft a mandatory provision. 72 Fed. Reg. 68700, 68707\n (Dec. 5, 2007).\n 17 OIG\xe2\x80\x99s Provider Self-Disclosure Protocol offers providers a method of coming forward to\n work openly and cooperatively with OIG to quantify a particular problem and ultimately to\n promote a higher level of ethical and lawful conduct throughout the health care industry.\n 63 Fed. Reg. 58399 (Oct. 30, 1998).\n 18 We did not include employer/union groups that contract directly with CMS in this\n study. However, some plan sponsors in our study provided national or regional plans to\n employer/union groups. These plans are included in our study.\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 5\n\x0cI N T R O D U C T I O N\n\n\n been terminated from the program, one was under investigation, and\n three did not respond to our data request in time to be included in our\n review.\n\n Of the 2,039 plans in our review, 1,332 were also offered to beneficiaries\n in 2006. For these 1,332 plans, we also collected data for the last\n 6 months of 2006.\n Data Collection\n Plan sponsors. We sent a data request to each plan sponsor that was on\n file in CMS\xe2\x80\x99s Health Plan Management System as of October 2007. We\n requested that the plan sponsors send us data regarding each of their\n plans.\n\n Thirteen plan sponsors in our study did not provide data by plan as we\n requested. These plan sponsors stated that they do not track their data\n at that level. Eight of these plan sponsors provided their data\n aggregated to the plan sponsor level. The other five plan sponsors\n provided data for each State and/or U.S. territory where their plans\n were offered.\n\n For the first 6 months of 2007 and, if applicable, the last 6 months of\n 2006, we asked each plan sponsor to provide the number of potential\n fraud and abuse incidents identified through internal efforts and the\n number of complaints received from external sources as defined by\n CMS. These external sources include CMS, MEDICs, law enforcement\n agencies, beneficiaries, and others. We also asked for the number and\n types of fraud and abuse identified, the number and types of persons or\n entities associated with the fraud and abuse incidents identified, the\n number of inquiries conducted, the number and types of corrective\n actions initiated as a result of the fraud and abuse identified, and the\n number of referrals for further investigation made to Government\n entities.\n Centers for Medicare & Medicaid Services. We collected information\n about the plan sponsors from CMS\xe2\x80\x99s Part D enrollment files and Health\n Plan Management System. We collected the number of plans offered,\n regions covered, and beneficiaries enrolled.\n Analysis\n For all plan sponsors in our study, we summarized responses for each\n question in our data request at the plan sponsor level. For the 73 plan\n sponsors that provided data by plan, we also summarized responses for\n each question at the plan level. We summarized data by State and U.S.\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 6\n\x0cI N T R O D U C T I O N\n\n\n territory for respondents that provided the data by those variables. We\n identified the mean, median, maximum, and minimum for each\n question.\n\n We also compared plan sponsors\xe2\x80\x99 responses based on the number of\n plans offered, regions covered, and beneficiaries enrolled.\n\n For plan sponsors that provided data for the last 6 months of 2006, we\n compared those data with data from the first 6 months of 2007.\n However, we did not include the 2006 information in this report because\n it was not significantly different from the 2007 data.\n\n We assigned an identification number to the plan sponsors in our review\n based on the number of potential fraud and abuse incidents they\n identified through internal efforts. We use these identification numbers\n in all of our report tables so that the reader can identify information\n related to the same plan sponsor across the different tables.\n\n Our findings that plan sponsors identified or did not identify potential\n fraud and abuse incidents are based on the numeric data that plan\n sponsors provided.\n Limitations\n We did not independently verify the information plan sponsors provided\n to us or to CMS\xe2\x80\x99s Health Plan Management System.\n\n We use the term \xe2\x80\x9cincident\xe2\x80\x9d (i.e., potential fraud and abuse incident) to\n represent an instance of misconduct or a violation, not the number of\n providers involved in the misconduct or violation. However, in our\n analysis of plan sponsor responses, we saw that the numbers plan\n sponsors provided for certain questions about fraud and abuse volume\n did not always match. One example was a plan sponsor that reported\n identifying a total of 92 incidents of potential fraud and abuse from\n internal and external sources but conducted only 46 inquiries. Another\n example was a plan sponsor that reported identifying a total of 66\n incidents of potential fraud and abuse but initiated 171 corrective\n actions. We did not determine why this information did not match.\n Standards\n This study was conducted in accordance with the \xe2\x80\x9cQuality Standards for\n Inspections\xe2\x80\x9d issued by the President\xe2\x80\x99s Council on Integrity and\n Efficiency and the Executive Council on Integrity and Efficiency.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 7\n\x0c \xce\x94 F I N D I N G S\n\n\n Overall, 24 of 86 Part D stand-alone plan Twenty-four plan sponsors\n sponsors did not identify any potential fraud (28 percent) did not identify any\nand abuse incidents; most potential fraud and incidents of potential fraud and\n abuse, either from internal efforts or\n abuse incidents were associated with only a\n complaints from external sources, in\n small number of plan sponsors\n the first 6 months of 2007.\n Sixty-two plan sponsors (72 percent)\n identified a total of 9,774 potential fraud and abuse incidents in this\n time period. Of these 62 plan sponsors, the number of incidents per\n plan sponsor ranged from 1 to 6,533, with a median of 11. Plan\n sponsors are not required to report to CMS the number of fraud and\n abuse incidents they identify, only the number of beneficiary complaints\n they receive.\n Most of these potential fraud and abuse incidents were associated with\n seven plan sponsors. As shown in Table 1, these seven plan sponsors\n represent 90 percent of the total number of potential fraud and abuse\n incidents (8,817 of 9,774). One of these seven plan sponsors identified\n 67 percent of the incidents. Although these seven plan sponsors\n identified most of the potential fraud and abuse incidents, only two of\n the seven are among the top seven plan sponsors with the largest\n beneficiary enrollment. Appendix A provides the number of potential\n fraud and abuse incidents identified and other information for 86 plan\n sponsors.\n\n\n Table 1. Top Seven Plan Sponsors That Identified the Most\n Potential Fraud and Abuse Incidents, First 6 Months of 2007\n\n Number of Percentage of All\n Plan Potential Fraud Potential Fraud Number of\n Sponsor and Abuse and Abuse Number of Regions\n ID Incidents Incidents1 Plans Offered Covered2\n 1 6,533 67% 104 34\n 33 860 9% 104 34\n 2 636 7% 107 35\n 14 258 3% 104 34\n 3 242 2% 2 1\n 10 166 2% 41 34\n 5 122 1% 101 33\n Total 8,817 90%\n Sources: CMS\xe2\x80\x99s Health Plan Management System data and OIG analysis of plan sponsor responses. \n\n 1 Percentages are affected by rounding.\n\n 2 National employer/union group plans are not included in this column. \n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 8\n\x0cF I N D I N G S\n\n\n Plan sponsors identified 78 percent of all potential fraud and abuse\n incidents through internal efforts; however, 42 plan sponsors did not\n identify any potential fraud and abuse through internal efforts\n Of the 9,774 incidents of potential fraud and abuse, 7,595 incidents\n (78 percent) were identified through internal efforts. An example of an\n internal effort is claim reviews. Forty-four plan sponsors (51 percent)\n identified potential fraud and abuse from internal efforts; 42 plan\n sponsors (49 percent) did not identify any potential fraud and abuse\n from internal efforts.\n\n One plan sponsor was associated with 84 percent of the potential fraud and\n abuse incidents identified through internal efforts. As shown in Table 2,\n one plan sponsor was responsible for 84 percent of the potential fraud\n and abuse incidents identified through internal efforts (6,410 of\n 7,595 incidents). Table 2 also shows that this plan sponsor, along with\n two additional plan sponsors, made up 95 percent of the potential fraud\n and abuse incidents identified from internal efforts. Appendix A\n provides data on all plan sponsors\xe2\x80\x99 internal efforts.\n\n\n Table 2. Top Three Plan Sponsors With the Most Potential Fraud and\n Abuse Incidents Identified Through Internal Efforts, First 6 Months of\n 2007\n\n Number of Incidents Plan Percentage of All Incidents\n Sponsors Identified Through Plan Sponsors Identified\n Plan Sponsor ID Internal Efforts Through Internal Efforts\n 1 6,410 84%\n 2 592 8%\n 3 242 3%\n Total 7,244 95%\n Source: OIG analysis of plan sponsor responses.\n\n\n Twenty-two percent of potential fraud and abuse incidents identified came\n from external sources; however, 34 plan sponsors did not identify any\n potential fraud and abuse incidents from external sources\n Of the 9,774 incidents of potential fraud and abuse identified by plan\n sponsors, 2,179 (22 percent) were complaints from external sources.\n Fifty-two plan sponsors (60 percent) had fraud and abuse complaints\n from external sources; 34 plan sponsors (40 percent) had no complaints\n from external sources. Of the 2,179 complaints from external sources,\n 80 were from law enforcement agencies, 936 were from CMS and\n MEDICs, and 1,163 were from beneficiaries and other sources such as\n pharmacy providers.\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 9\n\x0cF I N D I N G S\n\n\n Two plan sponsors were associated with 51 percent of these incidents.\n Two plan sponsors had the majority (51 percent) of the complaints from\n external sources. Appendix A provides the number of potential fraud\n and abuse incidents identified through external sources for all 86 plan\n sponsors.\n\n\n\n Inappropriate billing was the most prevalent Plan sponsors identified\n type of potential fraud and abuse incident 26 different types of fraud and\n identified; pharmacies were associated with abuse (both from internal efforts\n and complaints from external\nmost of the potential fraud and abuse incidents\n sources). Plan sponsors are not\n required to report to CMS the types of potential fraud and abuse they\n identify.\n Of the 26 types of potential fraud and abuse, the most prevalent type\n was inappropriate billing, with 9,073 incidents. An example of\n inappropriate billing is submitting claims for drugs not provided.\n\n The second most prevalent type of potential fraud and abuse identified\n by plan sponsors was providing false information, with 520 incidents.\n An example of providing false information is misrepresentation of a\n beneficiary\xe2\x80\x99s personal identity, eligibility, medical condition, or plan\n enrollment.\n\n The third most prevalent type of potential fraud and abuse identified by\n plan sponsors was doctor shopping, with 400 incidents. \xe2\x80\x9cDoctor\n shopping\xe2\x80\x9d is the term used for consulting a number of doctors for the\n purpose of inappropriately obtaining multiple prescriptions for drugs.\n\n Plan sponsors identified fewer than 152 incidents of each of the other\n 23 types of potential fraud and abuse. Appendix B provides the number\n and types of potential fraud and abuse reported by plan sponsors.\n\n Plan sponsors reported that pharmacies/pharmacists were the entities\n most often associated with potential fraud and abuse incidents. Plan\n sponsors reported that pharmacies/pharmacists were associated with\n 9,852 incidents (92 percent). 19 Plan sponsors reported that beneficiaries\n\n 19 The number 9,852 is higher than the 9,774 potential fraud and abuse incidents that\n plan sponsors identified. One possible explanation is that more than one person or entity\n was identified for each incident of potential fraud and abuse.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 10\n\x0c F I N D I N G S\n\n\n were associated with 591 incidents and sales or marketing brokers were\n associated with 124 incidents. Plan sponsors themselves were also\n listed as entities associated with potential fraud and abuse during this\n period. Table 3 shows the persons or entities plan sponsors reported as\n associated with potential fraud and abuse.\n\n\n\n Table 3. Persons or Entities Associated With Potential Fraud and\n Abuse Incidents, First 6 Months of 2007\n\n Person or Entity Number of Incidents\n Pharmacy/pharmacist 9,852\n Beneficiary 591\n Sales or marketing broker 124\n Third party 82\n Physician or other prescriber 56\n Plan sponsor 44\n PBM 6\n Family member 5\n Insurance agency/agent 3\n Claims adjudicator 2\n Drug manufacturer 1\n Total 10,7661\n Source: OIG analysis of plan sponsor responses.\n 1 The number 10,766 is higher than the total number of potential fraud and abuse incidents that plan\n\n sponsors identified and higher than the aggregated number of different types of fraud and abuse they\n reported. One possible explanation is that more than one person or entity was identified for each incident\n of potential fraud and abuse.\n\n\n Not all 62 plan sponsors that identified potential Three actions that plan sponsors\n fraud and abuse incidents conducted inquiries, can take after identifying\n potential fraud and abuse are\ninitiated corrective actions, or made referrals for\n conducting inquiries, initiating\n further investigation\n corrective actions, and referring\n incidents for further investigation.\n Plan sponsors are not required to report to CMS any data concerning\n the actions they take in response to potential fraud and abuse.\n Of the 62 plan sponsors that identified potential fraud and abuse,\n 47 conducted inquiries, 32 initiated corrective actions, and 33 referred\n incidents to other entities for further investigation. Overall, 17 plan\n sponsors initiated all three actions, 21 initiated two actions, 19 initiated\n one action, and 5 did not initiate any of these actions. Appendix A\n provides inquiry, corrective action, and referral information for all plan\n sponsors.\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 11\n\x0cF I N D I N G S\n\n\n Inquiries. Of the 62 plan sponsors that identified potential fraud and\n abuse, 47 conducted 1,904 inquiries during the review period. 20 Of\n these 1,904, one plan sponsor conducted 849 inquiries, or 45 percent.\n The top four plan sponsors conducted 72 percent of all these inquiries.\n\n CMS recommends that plan sponsors refer fraud and abuse incidents to\n MEDICs when they do not have the time or resources to conduct\n inquiries. Of 15 plan sponsors that identified potential fraud and abuse\n incidents but did not conduct inquiries, none sent any incidents to\n MEDICs because of time or resource constraints.\n\n Corrective actions. Of the 62 plan sponsors that identified potential\n fraud and abuse, 32 initiated 9,011 corrective actions. 21 The most\n frequent type of corrective action was repayment of overpayments, with\n 8,318 actions taken. One plan sponsor that initiated 71 percent of the\n corrective actions (6,410 of 9,011) used repayments to address\n 98 percent of its potential fraud and abuse incidents. The second most\n frequent type of corrective action initiated was termination from the\n network, with 476 actions taken. Table 4, on the next page, shows the\n number and types of corrective actions plan sponsors initiated and the\n number of sponsors that initiated each type.\n\n Three plan sponsors initiated a significantly higher number of\n corrective actions compared to the total number of potential fraud and\n abuse incidents they identified. These three plan sponsors initiated\n 795, 479, and 171 corrective actions, respectively, although they\n identified only 70, 2, and 66 potential fraud and abuse incidents.\n\n\n\n\n 20 One plan sponsor that had not identified any potential fraud and abuse during this\n period reported conducting one inquiry. Therefore, the total number of inquiries plan\n sponsors conducted during this time period is 1,905.\n 21 Two plan sponsors that had not identified any potential fraud and abuse during this\n period each reported initiating one corrective action. Therefore, the total number of\n corrective actions that plan sponsors initiated during this time period is 9,013.\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 12\n\x0cF I N D I N G S \n\n\n\n Table 4. Corrective Actions Initiated by Plan Sponsors, First 6 Months of 2007\n Number of Plan\n Number of Times Sponsors That\n Type of Correction Action Type Was Initiated Initiated Each Type1\n Repayment of erroneous payment or overpayment 8,318 20\n Termination from network 476 14\n Disciplinary action 158 8\n Correction of data 16 4\n Utilization monitoring 8 1\n Premium or true out-of-pocket cost adjustment 6 1\n Reverse processing of erroneous prescriptions 6 1\n Oversight 2 1\n Unidentified 21 4\n Total 9,011\n Source: OIG analysis of plan sponsor responses.\n\n 1Column cannot be totaled because some plan sponsors are represented in more than one row. \n\n\n\n\n\n Referrals. Of the 62 plan sponsors that identified potential fraud and \n\n abuse incidents, 33 made at least 1 referral for further investigation, for \n\n a total of 1,701 referrals. 22 The referrals were made to CMS, \n\n Department of Justice agencies, local law enforcement agencies, \n\n MEDICs, OIG, State agencies, and other plan sponsors.\n\n Eighty-nine percent of these referrals went to MEDICs (1,522 of 1,701). \n\n Two plan sponsors made 89 percent of the referrals to MEDICs \n\n (1,347 of 1,522). \n\n\n\n\n\n 22 One plan sponsor that reported not identifying any potential fraud and abuse during\n this period also reported referring three incidents of potential fraud and abuse for further\n investigation. Therefore, the total number of referrals for further investigation during this\n time period is 1,704.\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 13\n\x0c\xce\x94 R E C O M M E N D A T I O N S\n\n\n\n Plan sponsors are the first line of defense against Part D fraud and\n abuse. They are required to have a comprehensive program to detect\n and deter Part D fraud and abuse. However, we found that some of\n these plan sponsors did not identify any potential fraud and abuse\n incidents; most incidents were identified by a small number of plan\n sponsors; and not all plan sponsors that identified potential fraud and\n abuse conducted inquiries, initiated corrective actions, or made referrals\n for further investigation.\n\n CMS does not routinely collect information that would describe the\n overall volume or types of Part D fraud and abuse that occur or other\n outcome-related information that would inform CMS as to the\n effectiveness of the comprehensive fraud and abuse plan each sponsor is\n required to have in place. The only information concerning fraud and\n abuse that CMS requires to be reported is the quarterly aggregate\n number of fraud and abuse complaints that plan sponsors received from\n beneficiaries. There is no required reporting to CMS of information\n relating to self-identified instances of fraud or allegations received from\n sources other than beneficiaries. Further, the data CMS collects about\n beneficiary complaints to plan sponsors do not provide information\n about whether, or how effectively, the plan sponsors addressed the\n allegations.\n\n A crucial aspect of protecting the integrity of the Part D program is\n ensuring that the plan sponsors have in place a comprehensive and\n effective program to detect and deter fraud and abuse. Therefore, we\n recommend that CMS:\n Review Part D plan sponsors to determine why certain sponsors have\n identified especially high or low volumes of potential fraud and abuse\n incidents.\n\n Determine whether the Part D plan sponsors that identified potential fraud\n and abuse initiated inquiries and corrective actions as required by CMS, and\n made referrals for further investigation as recommended by CMS.\n\n Require Part D plan sponsors to maintain and routinely report information\n related to the results of sponsors\xe2\x80\x99 fraud and abuse programs.\n Such information should include, but not be limited to, the number and\n types of potential fraud and abuse incidents identified through internal\n efforts and external sources, the number of inquiries conducted into\n potential fraud and abuse, the number and types of corrective actions\n\nOEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 14\n\x0cR E C O M M E N D A T I O N S\n\n\n initiated, the number of referrals for further investigation, and the\n types of agencies to which referrals were sent. Moreover, all categories\n of required information should be clearly defined to prevent\n misinterpretation and to ensure that information from different sources\n can be compared.\n Use this required information to help determine the effectiveness of\n sponsors\xe2\x80\x99 fraud and abuse programs.\n\n\n AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL\n RESPONSE\n CMS stated that it is committed to combating fraud, waste, and abuse\n in the Part D program but that because of limited funding, it has not\n been able to perform as much direct oversight of the Part D sponsors\xe2\x80\x99\n fraud, waste, and abuse efforts as it anticipated.\n\n CMS questioned the validity of our report numbers and stated that\n incidents might include beneficiary misunderstandings, a sponsor\xe2\x80\x99s\n noncompliance, and incidents of potential fraud.\n\n The data that we requested from sponsors were specifically about\n potential fraud and abuse incidents. We asked sponsors to provide us\n the number of potential fraud and abuse incidents that they identified\n through internal efforts and the number of potential fraud and abuse\n incidents that they identified through external sources (e.g., law\n enforcement agencies, MEDICs, providers, and beneficiaries). We used\n terms from two CMS sources: (1) the \xe2\x80\x9cPrescription Drug Benefit\n Manual,\xe2\x80\x9d chapter 9, which provides guidance on fraud and abuse\n programs; and (2) the CMS instructions to sponsors for reporting\n beneficiary complaint numbers. We agree that potential fraud and\n abuse incidents should be further defined by CMS to ensure\n comparability of data across sponsors and this is included in our third\n recommendation.\n\n In response to OIG\xe2\x80\x99s first recommendation, CMS stated that it agreed\n that the variability in the number of potential fraud and abuse incidents\n identified by sponsors is a concern. CMS will examine the data more\n closely by referring the findings to MEDICs for further investigation.\n CMS also stated that it intends to revise the reporting requirements to\n enhance the data collected and give sponsors more specific guidance on\n how to track and properly label incidents, e.g., as an education issue or\n a potential fraud issue.\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 15\n\x0cR E C O M M E N D A T I O N S\n\n\n CMS concurred with OIG\xe2\x80\x99s second recommendation and will refer the\n data in this report to MEDICs for further investigation.\n\n Although CMS provided comments about OIG\xe2\x80\x99s third recommendation,\n CMS did not state whether it concurred. CMS did state that OIG\xe2\x80\x99s\n report would be useful when CMS initiates its Part D sponsor\n compliance plan audits. CMS stated that our report will help ensure\n that sponsors are conducting their own internal investigations and\n taking appropriate corrective actions. CMS did not address OIG\xe2\x80\x99s\n fourth recommendation.\n\n CMS provided technical comments. CMS stated that the number of\n complaint categories in the Complaint Tracking Module should be\n 10 and not 11 as stated on page 3 of the report. We did not change the\n number of complaint categories because there is an 11th category in the\n Complaint Tracking Module (\xe2\x80\x9cOther\xe2\x80\x9d).\n\n CMS stated that our methodology would be improved by including\n information about enrollments. However, during a meeting with CMS\n about our findings, prior to the issuance of our draft report, CMS staff\n requested that OIG remove enrollment information from the tables in\n the report because they believed that readers could use it to identify\n sponsors. OIG has provided CMS with a crosswalk to identify sponsors\n in our report tables for further analysis or followup.\n\n We ask that, in its final management decision, CMS more clearly\n indicate whether it concurs with our third and fourth recommendations\n and what steps, if any, it will take to implement them. The full text of\n CMS\xe2\x80\x99s comments is provided in Appendix C.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 16\n\x0c\xce\x94 A P P E N D I X ~ A\n\n\n\n\nThe table below provides information about the 86 Part D stand-alone drug plan sponsors\nreviewed in this report. The information is sorted by the number of potential fraud and abuse\nincidents plan sponsors identified through internal efforts.\n\n\n\nSelected Fraud and Abuse Activities for Stand-Alone Drug Plan Sponsors, First 6 Months of 2007\n Number of Number of\n Potential Potential\n Fraud and Fraud and Total\n Abuse Abuse Number of\n Incidents Incidents Potential Number of\n Identified Identified Fraud and Number of Referrals to\nPlan Number Number of Through Through Abuse Number of Corrective Other Entities\nSponsor of Plans Regions Internal External Incidents Inquiries Actions for Further\nID Offered Covered1 Efforts Sources2 Identified Conducted Initiated Investigation\n1 104 34 6,410 123 6,533 0 6,410 0\n2 107 35 592 44 636 30 565 6\n3 2 1 242 0 242 242 154 0\n4 2 1 37 3 40 0 20 0\n5 101 33 33 89 122 122 10 16\n6 107 31 30 62 92 46 0 46\n7 4 1 27 0 27 0 27 0\n8 85 38 22 44 66 51 171 18\n9 104 34 21 49 70 65 795 827\n10 41 34 20 146 166 166 0 0\n11 5 1 15 3 18 17 0 2\n12 2 1 13 0 13 5 0 8\n13 56 33 12 27 39 20 0 0\n14 104 34 9 249 258 18 14 38\n15 5 1 9 2 11 11 0 2\n16 2 1 9 1 10 10 7 4\n17 70 34 8 24 32 0 8 11\n18 69 21 8 17 25 10 0 0\n19 17 1 7 9 16 8 0 8\n20 4 1 7 1 8 8 0 0\n21 5 1 6 0 6 6 0 8\n22 5 1 5 10 15 14 1 6\n23 110 36 4 88 92 19 0 4\n24 68 33 4 73 77 2 0 6\n25 92 34 4 13 17 17 17 0\n26 3 1 4 3 7 7 10 0\n27 1 1 4 0 4 4 0 3\n28 4 1 4 0 4 4 0 4\n29 15 3 3 16 19 19 11 6\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 17\n\x0c A P P E N D I X ~ A \n\n\n\n\n\nSelected Fraud and Abuse Activities for Stand-Alone Drug Plan Sponsors, First 6 Months of 2007\n(continued)\n Number of Number of Total\n Potential Potential Number\n Fraud and Fraud and of\n Abuse Abuse Potential\n Incidents Incidents Fraud Number of\n Identified Identified and Number of Referrals to\nPlan Number of Number of Through Through Abuse Number of Corrective Other Entities\nSponsor Plans Regions Internal External Incidents Inquiries Actions for Further\nID Offered Covered1 Efforts Sources2 Identified Conducted Initiated Investigation\n30 42 12 3 10 13 5 0 0\n31 4 2 3 5 8 0 0 0\n32 2 1 3 3 6 0 0 1\n33 104 34 2 858 860 849 209 624\n34 2 1 2 10 12 12 2 8\n35 6 1 2 5 7 6 6 3\n36 3 1 2 0 2 0 479 0\n37 2 1 2 0 2 2 2 0\n38 68 34 1 59 60 0 57 3\n39 3 1 1 11 12 12 1 23\n40 104 34 1 5 6 5 1 3\n41 67 33 1 4 5 3 3 3\n42 5 1 1 3 4 4 1 1\n43 5 1 1 0 1 0 2 1\n44 3 1 1 0 1 1 0 0\n45 4 1 0 34 34 32 0 3\n46 14 7 0 14 14 14 0 0\n47 9 1 0 13 13 1 13 0\n48 3 1 0 10 10 10 8 0\n49 4 1 0 7 7 7 0 0\n50 4 1 0 4 4 0 0 0\n51 2 1 0 4 4 3 0 0\n52 4 1 0 4 4 4 0 0\n53 56 24 0 3 3 3 1 0\n54 6 2 0 3 3 3 3 2\n55 3 1 0 3 3 3 0 0\n56 4 1 0 2 2 2 2 2\n57 2 1 0 2 2 2 0 0\n58 2 1 0 2 2 0 0 0\n59 4 1 0 2 2 0 0 0\n60 4 1 0 1 1 0 1 0\n61 4 1 0 1 1 0 0 1\n62 1 1 0 1 1 0 0 0\n63 33 10 0 0 0 0 0 0\n64 36 34 0 0 0 0 0 0\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 18\n\x0c A P P E N D I X ~ A \n\n\n\n\n\nSelected Fraud and Abuse Activities for Stand-Alone Drug Plan Sponsors, First 6 Months of\n2007 (continued)\n Number of Number of Total\n Potential Potential Number\n Fraud and Fraud and of\n Abuse Abuse Potential\n Incidents Incidents Fraud Number of\n Identified Identified and Number of Referrals to\nPlan Number of Number of Through Through Abuse Number of Corrective Other Entities\nSponsor Plans Regions Internal External Incidents Inquiries Actions for Further\nID Offered Covered1 Efforts Sources2 Identified Conducted Initiated Investigation\n65 3 1 0 0 0 0 0 0\n66 4 1 0 0 0 0 0 0\n67 4 1 0 0 0 0 0 0\n68 5 1 0 0 0 0 0 0\n69 5 1 0 0 0 0 0 0\n70 37 35 0 0 0 0 0 0\n71 4 1 0 0 0 1 1 3\n72 6 3 0 0 0 0 0 0\n73 4 1 0 0 0 0 0 0\n74 9 1 0 0 0 0 0 0\n75 10 5 0 0 0 0 0 0\n76 2 1 0 0 0 0 0 0\n77 4 1 0 0 0 0 0 0\n78 2 1 0 0 0 0 1 0\n79 4 1 0 0 0 0 0 0\n80 4 1 0 0 0 0 0 0\n81 3 1 0 0 0 0 0 0\n82 2 1 0 0 0 0 0 0\n83 3 1 0 0 0 0 0 0\n84 4 1 0 0 0 0 0 0\n85 4 1 0 0 0 0 0 0\n86 3 1 0 0 0 0 0 0\n Total 2,039 7,595 2,179 9,774 1,905 9,013 1,704\nSources: Centers for Medicare & Medicaid Services\xe2\x80\x99 Health Plan Management System data, and Office of Inspector General analysis of\nplan sponsor responses.\n1 There are 39 stand-alone drug plan regions. Of the 39, 25 include only one State, 9 include multiple States, and 5 include one\n\nU.S. territory each. The national employer/union group plans in our review are not included in the count of regions for this column.\n2 This column includes complaints that plan sponsors received from CMS, Medicare Drug Integrity Contractors, law enforcement\n\nagencies, beneficiaries, and others.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 19\n\x0c \xce\x94 A P P E N D I X ~ B\n\n\n\nExamples in this table came from the Centers for Medicare & Medicaid Services (CMS),\n\xe2\x80\x9cPrescription Drug Benefit Manual,\xe2\x80\x9d chapter 9, sections 70.1 through 70.1.7; Medicare Drug\nIntegrity Contractors\xe2\x80\x99 internal categories for complaints; and plan sponsor responses to our\nreview questions.\n\n\n\n Types of Potential Fraud and Abuse Identified by Stand-Alone Drug Plan Sponsors, First 6 Months of 2007\n\n\n Type of Fraud Number of\n and Abuse Incidents Examples\n \xe2\x80\xa2 Billing for drugs or services not provided.\n \xe2\x80\xa2 Billing multiple payers for the same prescriptions, except as required\n Inappropriate for coordination of benefit transactions.\n 9,073\n Billing \xe2\x80\xa2 Billing based on group visits, e.g., a pharmacist visits a nursing home\n and bills for numerous prescriptions without furnishing any specific\n service to individual patients.\n\n\n \xe2\x80\xa2 Plan sponsor or subcontractor falsified information furnished to CMS.\n \xe2\x80\xa2 Prescriber falsified information submitted through a prior authorization\n Providing False\n 520 or other formulary oversight mechanism in order to justify coverage.\n Information\n \xe2\x80\xa2 Misrepresentation of beneficiary's personal identity or eligibility\n information, medical condition, or plan enrollment information.\n\n\n \xe2\x80\xa2 Beneficiary consulted a number of doctors for the purpose of\n Doctor\n 400 inappropriately obtaining multiple prescriptions for narcotic painkillers\n Shopping\n or other drugs.\n\n Attempting To \xe2\x80\xa2 Beneficiary was asked for credit card or banking information.\n Steal \xe2\x80\xa2 Beneficiary was asked for payment over the telephone or Web.\n 151\n Beneficiary \xe2\x80\xa2 Individual or organization posed as Medicare or Social Security with\n Identity/Money intent to steal beneficiary's identity or money.\n\n Engaging in\n \xe2\x80\xa2 Plan sponsor or subcontractor violated Medicare marketing guidelines\n Improper\n 139 or other Federal or State laws, rules, and regulations to improperly\n Marketing\n enroll beneficiaries in a Part D plan.\n Schemes\n \xe2\x80\xa2 Overcharging beneficiary for coinsurance or premium.\n \xe2\x80\xa2 Pharmacy asked beneficiary to pay uncompensated amounts.\n Overcharging\n 58 \xe2\x80\xa2 Bait and switch pricing, i.e., beneficiary is led to believe a drug will\n Beneficiary cost one price, but at point of sale beneficiary is charged a higher\n amount.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 20\n\x0cA P P E N D I X ~ B \n\n\n\n\n\nTypes of Potential Fraud and Abuse Identified by Stand-Alone Drug Plan Sponsors, First 6 Months of 2007 (continued)\n\nType of Fraud Number of\nand Abuse Incidents Examples\n\n \xe2\x80\xa2 Dispensed expired or adulterated prescription drugs.\nInappropriate\n \xe2\x80\xa2 Dispensed drugs without a prescription.\nPrescription 50\nDispensing \xe2\x80\xa2 Pharmacist or pharmacy benefit manager\xe2\x80\x99s (PBM) mail order pharmacy\n split prescription to receive additional dispensing fee.\n\n \xe2\x80\xa2 Beneficiary obtained prescription drugs from a provider and gave or sold\n this medication to someone else.\nDiverting\n 33 \xe2\x80\xa2 Inappropriate consumption or distribution of a beneficiary's medications\nPrescriptions\n by a caregiver or anyone else.\n \xe2\x80\xa2 Beneficiary resale of drugs on black market.\n\n \xe2\x80\xa2 Submitted inaccurate or incomplete prescription drug event data or Part D\nProviding Data plan quarterly data.\nThat Lacks 27 \xe2\x80\xa2 Improperly reported enrollment/disenrollment data to CMS to inflate\nIntegrity to CMS prospective payments.\n \xe2\x80\xa2 Inappropriately documented pricing information.\n\n \xe2\x80\xa2 Prescriptions were altered by someone other than the prescriber or\n pharmacist with prescriber approval to increase quantity or number of\nForging/Altering\n 27 refills.\nDocuments\n \xe2\x80\xa2 Altered prescription, electronic claim records, medical document, etc., for\n greater payment.\n\nInappropriate \xe2\x80\xa2 Beneficiary was dead at the time of enrollment.\nEnrollment/ 26 \xe2\x80\xa2 Beneficiary enrolled under multiple plans.\nDisenrollment \xe2\x80\xa2 Involuntary termination of enrollee for nonpayment of premium.\n\nEngaging in\n \xe2\x80\xa2 Possible controlled substance abuse.\nPotential Drug 22\n \xe2\x80\xa2 Outlier nonnarcotic; wasteful and potentially abusive drug use.\nAbuse\n\nBilling the Wrong\n 8 \xe2\x80\xa2 Wrong person charged for prescription.\nPerson\n\nInappropriate \xe2\x80\xa2 Off-label prescribing of controlled substance.\n 7\nPrescribing \xe2\x80\xa2 Prescriber is on Office of Inspector General\xe2\x80\x99s (OIG) Exclusion List.\n\n \xe2\x80\xa2 Plan sponsor provided false or misleading information regarding the\n number of its members who applied and qualified for the low-income\nMisusing Low- subsidy in order to receive unwarranted low-income subsidy payments.\n 5\nIncome Subsidy \xe2\x80\xa2 Beneficiary not reimbursed by plan following retroactive low income\n subsidy determination.\n \xe2\x80\xa2 Beneficiary not receiving the low-income benefit approved by CMS.\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 21\n\x0cA P P E N D I X ~ B \n\n\n\n\n\nTypes of Potential Fraud and Abuse Identified by Stand-Alone Drug Plan Sponsors, First 6 Months of 2007 (continued)\n\n\nType of Fraud Number of \n\nand Abuse\n Incidents Examples\nTheft of \xe2\x80\xa2 In context of e-prescribing, includes theft of provider's authentication,\nPrescriber\xe2\x80\x99s 5 i.e., login, information, including Drug Enforcement Administration\nPrescription Pad number.\n\n \xe2\x80\xa2\t Selected/denied beneficiaries based on illness profile or other\nAdverse Selecting 4\n discriminating factors.\n\n \xe2\x80\xa2\t Prescriber was offered or paid, solicited, or received unlawful\n remuneration to induce or reward the prescriber to write prescriptions\nIllegal for drugs.\nRemuneration, 4 \xe2\x80\xa2 PBM received unlawful remuneration in order to steer a beneficiary\nKickbacks, Bribes toward a certain plan or drug.\n \xe2\x80\xa2\t Inappropriate discounts, support services, educational grants, and\n research funding.\n\n \xe2\x80\xa2 Any manipulation/miscalculation of beneficiary's TrOOP to keep\nInappropriate beneficiary in the coverage gap.\nManipulation of \xe2\x80\xa2\t Plan sponsor did not correctly calculate amount beneficiary spent on\n 4\nTrue Out-of-Pocket prescription out of pocket.\nCosts (TrOOP) \xe2\x80\xa2\t Beneficiary manipulated TrOOP to push through the coverage gap to\n reach catastrophic coverage before being eligible.\n\n \xe2\x80\xa2\t Plan sponsor, PBM, or PBM's pharmacy and therapeutics committees\n made decisions in which costs took priority over criteria such as clinical\n efficacy and appropriateness of formulary drugs.\nInappropriate Drug\n \xe2\x80\xa2\t Inappropriate formulary support activities such as inappropriate\nFormulary 3\n payments to PBMs, and formulary placement payments in order to have\nDecisions\n manufacturer's products included on a plan's formulary.\n \xe2\x80\xa2\t Bait and switch, i.e., frequent formulary changes to induce beneficiaries\n to sign up for specific drugs that are later removed.\n\n \xe2\x80\xa2\t Beneficiary attempted to game her/his drug coverage by obtaining and\n storing large quantities of drugs and then disenrolling, thus avoiding\nStockpiling 3\n out-of-pocket costs, to protect against periods of noncoverage, or to sell\n drugs on black market.\n\n\n \xe2\x80\xa2\t Manufacturer provided free samples to physicians expecting those\n physicians to bill Federal health care programs for the samples.\nInappropriate Sales\n \xe2\x80\xa2\t Illegal promotion of off-label drug usage through marketing, financial\nTechnique by 2\n incentives, or other promotion campaigns.\nManufacturer\n \xe2\x80\xa2\t Inappropriate marketing or promotion of drugs/products (sales,\n marketing, discounting) by manufacturer.\n\nPrescribing Outside\n 2 \xe2\x80\xa2\t Providers wrote prescriptions outside of their scope of practice.\nScope of Practice\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 22\n\x0c A P P E N D I X ~ B \n\n\n\n\n\nTypes of Fraud and Abuse Identified by Stand-Alone Drug Plan Sponsors, First 6 Months of 2007 (continued)\n\n\nType of Fraud Number of\nand Abuse Incidents Examples\n\n \xe2\x80\xa2 Providers wrote prescriptions for drugs that were not medically\n necessary, often in mass quantities, and often for patients that were not\nMass Prescribing 2 theirs. These prescriptions were often written for controlled drugs for\n sale on the black market and might include improper payments to the\n provider. This practice is sometimes called a prescription mill.\n\n\nHiding/Siphoning \xe2\x80\xa2 Arrangements by providers with pharmacies, PBMs, etc. to hide/siphon\n 1\nIllegal Profits illegal profits.\n\nSeeking Early\n 1 \xe2\x80\xa2 Beneficiary sought early refills.\nRefills\n 1\n Total 10,577\n\nSource of numeric data: OIG analysis of plan sponsor responses.\n\n1 The number 10,577 is higher than the 9,774 potential fraud and abuse incidents that plan sponsors reported identifying from internal efforts and \n\n\ncomplaints from external sources. One possible explanation for the higher number is that more than one type of fraud and abuse was identified \n\nper incident.\n\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 23\n\x0c\xce\x94 A P P E N D I X ~ C\n\n\n Agency Comments\n\n\n\n\nOEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 24\n\x0cA P P E N D I X ~ C\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 25\n\x0cA P P E N D I X ~ C\n\n\n\n\n OEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 26\n\x0c\xce\x94 A C K N O W L E D G M E N T S\n\n\n\n This report was prepared under the direction of Robert A. Vito, Regional\n Inspector General for Evaluation and Inspections in the Philadelphia\n regional office, and Linda M. Ragone, Deputy Regional Inspector\n General.\n\n Isabelle Buonocore served as the team leader for this study. Other\n principal Office of Evaluation and Inspections staff from the\n Philadelphia regional office who contributed to the report include\n Conswelia McCourt; central office staff who contributed include Linda\n Abbott and Sandy Khoury.\n\n\n\n\nOEI-03-07-00380 M E D I C A R E D R U G P L A N S P O N S O R S \xe2\x80\x99 I D E N T I F I C AT I O N OF POTENTIAL FRAUD AND ABUSE 27\n\x0c"


type: contracts

jurisdiction: EU

text:
 Avis juridique important
 |
 21995D1004(01)
 95/394/EF: Afgørelse nr. 2/94 truffet af Den Blandede Komité EØF-Finland af 19. december 1994 om supplering og ændring af bilag III til protokol nr. 3 angående definitionen af begrebet »varer med oprindelsesstatus« og angående metoderne for administrativt samarbejde, i henhold til fælleserklæringen vedrørende fornyet undersøgelse af ændringerne af oprindelsesreglerne på baggrund af indførelsen af det harmoniserede system
 EF-Tidende nr. L 235 af 04/10/1995 s. 0015 - 0017
 AFGØRELSE Nr. 2/94 TRUFFET AF DEN BLANDEDE KOMITÉ EØF-FINLAND af 19. december 1994 om supplering og ændring af bilag III til protokol nr. 3 angående definitionen af begrebet »varer med oprindelsesstatus« og angående metoderne for administrativt samarbejde, i henhold til fælleserklæringen vedrørende fornyet undersøgelse af ændringerne af oprindelsesreglerne på baggrund af indførelsen af det harmoniserede system (1*)(95/394/EF) DEN BLANDEDE KOMITÉ HAR -under henvisning til overenskomsten mellem Det Europæiske Økonomiske Fællesskab og Republikken Finland, undertegnet den 5. oktober 1973 i Bruxelles,under henvisning til protokol nr. 3 angående definitionen af begrebet »varer med oprindelsesstatus« og angående metoderne for administrativt samarbejde, i det følgende benævnt »protokol nr. 3«, særlig artikel 28, ogud fra følgende betragtninger:I fælleserklæringen, som er knyttet til afgørelse nr. 1/88 truffet af Den Blandede Komité EØF-Finland, hedder det, at der på visse betingelser kan foretages en fornyet undersøgelse af ændringerne til oprindelsesreglerne på baggrund af indførelsen af det harmoniserede system, hvis disse ændringer resulterer i en situation, der er til skade for de pågældende sektorers interesser; det hedder desuden, at den pågældende oprindelsesregel på ny udformes, som den var inden afgørelse nr. 1/88;oprindelsesreglerne for copolymerer henhørende under HS-pos. 39.01-39.21, polyester henhørende under HS-pos. ex 39.07, cellulose og kemiske derivater deraf, ikke andetsteds tariferet, i ubearbejdet form, henhørende under HS-pos. 39.12, ark af regenereret cellulose, polyamider og polyethylen henhørende under HS-pos. ex 39.20 samt raffineret kobber, i ubearbejdet form, henhørende under HS-pos. ex 74.03, som fastsat i afgørelse nr. 1/88, truffet af Den Blandede Komité EØF-Finland, bør ændres, således at reglerne udformes, som de var inden indførelsen af det harmoniserede system -TRUFFET FØLGENDE AFGØRELSE:Artikel 1 Positionerne og de dertil henhørende regler i bilaget til denne afgørelse erstatter de tilsvarende positioner og regler i bilag III til protokol nr. 3 til overenskomsten EØF-Finland.Artikel 2 Denne afgørelse træder i kraft den 1. januar 1988.Udfærdiget i Bruxelles, den 19. december 1994.På Den Blandede Komités vegneG. AVERYFormand(1*) Oversættelse.BILAG >TABELPOSITION>


type: wikipedia

text:
Montemiletto község (comune) Olaszország Campania régiójában, Avellino megyében.
 Fekvése
 A megye északkeleti részén fekszik. Határai: Lapio, Montefalcione, Montefusco, Pietradefusi, Prata di Principato Ultra, Pratola Serra, Santa Paolina, Taurasi és Torre Le Nocelle.
 Története
 A települést valószínűleg a longobárd időkben, a 8. században alapították. A következő századokban nemesi birtok volt. A 19. században nyerte el önállóságát, amikor a Nápolyi Királyságban felszámolták a feudalizmust.
 Népessége
 A népesség számának alakulása:
 Főbb látnivalói
 Castello (a középkori vár)
 Sant’Anna-templom
 Jegyzetek
 Források
 Comuni-Italiani
 Italy World Club
 Avellino megye települései


type: legislation

text:
 3.6.2015
 BG
 Официален вестник на Европейския съюз
 L 136/1
 РЕГЛАМЕНТ ЗА ИЗПЪЛНЕНИЕ (ЕС) 2015/858 НА КОМИСИЯТА
 от 29 май 2015 година
 за одобрение на изменение, което не е несъществено, в продуктовата спецификация на наименование, вписано в Регистъра на защитените наименования за произход и защитените географски указания [Uva de mesa embolsada del Vinalopó (ЗНП)]
 ЕВРОПЕЙСКАТА КОМИСИЯ,
 като взе предвид Договора за функционирането на Европейския съюз,
 като взе предвид Регламент (ЕС) No 1151/2012 на Европейския парламент и на Съвета от 21 ноември 2012 г. относно схемите за качество на селскостопанските продукти и храни (1), и по-специално член 52, параграф 2 от него,
 като има предвид, че:
 (1)
 В съответствие с член 53, параграф 1, първа алинея от Регламент (ЕС) No 1151/2012 Комисията разгледа заявлението на Испания за одобрение на изменение в продуктовата спецификация на защитеното наименование за произход „Uva de mesa embolsada del Vinalopó“, регистрирано по силата на Регламент (ЕО) No 1107/96 на Комисията (2).
 (2)
 Тъй като въпросното изменение не е несъществено по смисъла на член 53, параграф 2 от Регламент (ЕС) No 1151/2012, в съответствие с член 50, параграф 2, буква а) от същия регламент Комисията публикува заявлението за изменение в Официален вестник на Европейския съюз
 (3).
 (3)
 Тъй като Комисията не получи никакви възражения по член 51 от Регламент (ЕС) No 1151/2012, изменението в продуктовата спецификация следва да бъде одобрено,
 ПРИЕ НАСТОЯЩИЯ РЕГЛАМЕНТ:
 Член 1
 Одобрява се публикуваното в Официален вестник на Европейския съюз изменение в продуктовата спецификация на наименованието „Uva de mesa embolsada del Vinalopó“ (ЗНП).
 Член 2
 Настоящият регламент влиза в сила на двадесетия ден след деня на публикуването му в Официален вестник на Европейския съюз.
 Настоящият регламент е задължителен в своята цялост и се прилага пряко във всички държави членки.
 Съставено в Брюксел на 29 май 2015 година.
 За Комисията,
 от името на председателя,
 Phil HOGAN
 Член на Комисията
 (1) ОВ L 343, 14.12.2012 г., стр. 1.
 (2) Регламент (ЕО) No 1107/96 на Комисията от 12 юни 1996 г. относно регистриране на географски указания и наименования за произход по процедурата, предвидена в член 17 на Регламент (ЕИО) No 2081/92 на Съвета (ОВ L 148, 21.6.1996 г., стр. 1).
 (3) ОВ C 18, 21.1.2015 г., стр. 6.


text:
The Ethiopia Commodity Exchange (ECX) is a commodities exchange established April 2008 in Ethiopia. In Proclamation 2007-550, which created the ECX, its stated objective was "to ensure the development of an efficient modern trading system" that would "protect the rights and benefits of sellers, buyers, intermediaries, and the general public."
 The ECX is set up as a private company owned by a partnership of the market actors, members of the exchange, and the Ethiopian government, led by Eleni Gebre Medhin a former economist for the International Food Policy Research Institute and the World Bank. As of July 2011, the physical presence of the ECX consists of 55 warehouses in 17 regional locations. It has grown from trading 138,000 tons in its first year to 508,000 tons in its third year, with nearly equal shares of coffee and oilseeds and pulses. The value of the ECX rose 368% between 2010 and 2011 to reach US$1.1 billion. As of November 2010, the trading floor in Addis Ababa handled 200 spot contracts in commodities such as coffee, sesame, navy beans, maize and wheat. It was assessed in July 2011 that membership equaled 243 with clients, who trade through members, about 7,800. Farmer cooperatives represented 2.4 million smallholder farmers, which make up 12% of the membership.
 Currently, the ECX is the only stock or commodity exchange in Africa to have streamlined payment transfers down to "T+1" (ext day payment after a trade) from its clearinghouse to its partner commercial banks. Market data reach is expansive. "Push" price date is transmitted in real time to outdoor electronic ticker boards in 32 rural sites, the ECX website, 256,000 mobile subscribers via instant messaging, the radio, TV and print media. "Pull" market data is available through a toll-free phone-in service. The service received more than 1 million calls in September 2011, 70% coming from rural callers.
 The first year of the Ethiopia Commodity Exchange's existence is documented in the PBS Wide Angle film The Market Maker.
 References
 External links
 The Ethiopia Commodity Exchange (ECX)
 TED Talk about the ECX (by Elene Gabre-Madhin)
 Commodity exchanges
 Companies of Ethiopia
 2008 establishments in Ethiopia


type: caselaw

text:
 1.6.2013
 PT
 Jornal Oficial da União Europeia
 C 156/42
 Despacho do Tribunal Geral de 9 de abril de 2013 — British Sugar/Comissão
 (Processo T-86/10) (1)
 (Agricultura - Açúcar - Quotizações à produção - Anulação e declaração de invalidade parciais do Regulamento (CE) n.o 1193/2009 após interposição do recurso - Não conhecimento do mérito)
 2013/C 156/79
 Língua do processo: inglês
 Partes
 Recorrente: British Sugar plc (Londres, Reino Unido) (representantes: inicialmente K. Lasok, QC, G. Facenna, barrister, W. Robinson, P. Doris e D. Das, solicitors, depois K. Lasok, G. Facenna, W. Robinson e D. Das)
 Recorrida: Comissão Europeia (representantes: K. Banks e P. Rossi, agentes)
 Intervenientes em apoio da recorrente: Reino de Espanha (representantes: inicialmente F. Díez Moreno, depois A. Rubio Gomzález, abogados del Estado); e República da Lituânia (representantes: R. Janeckaitė e R. Krasuckaitė, agentes)
 Intervenientes em apoio da recorrida: República da Letónia (representantes: K. Drēviņa e K. Krasovska, agentes); e Reino Unido da Grã-Bretanha e da Irlanda do Norte (representantes: inicialmente S. Bezhadi-Specer e S. Hathaway, depois S. Behzadi-Spencer e A. Robinson, agentes)
 Objeto
 Pedido de anulação do Regulamento (CE) n.o 1193/2009 da Comissão, de 3 de novembro de 2009, que retifica os Regulamentos (CE) n.o 1762/2003, (CE) n.o 1775/2004, (CE) n.o 1686/2005, (CE) n.o 164/2007 e fixa, para as campanhas de comercialização de 2002/2003, 2003/2004, 2004/2005, 2005/2006, os montantes das quotizações à produção no sector do açúcar (JO L 321, p. 1).
 Dispositivo
 1.
 Não há que conhecer do mérito do presente recurso.
 2.
 A Comissão Europeia é condenada a suportar as suas próprias despesas bem como as da British Sugar plc.
 3.
 O Reino de Espanha, a República da Letónia, a República da Lituânia e o Reino Unido da Grã-Bretanha e da Irlanda do Norte suportarão as suas próprias despesas.
 (1) JO C 113 de 1.5.2010


text:
 Avis juridique important
 |
 21997D0710(15)
 ETA:n sekakomitean päätös N:o 16/97, tehty 26 päivänä maaliskuuta 1997, ETA-sopimuksen liitteen II (Tekniset määräykset, standardit, testaus ja varmentaminen) muuttamisesta
 Virallinen lehti nro L 182 , 10/07/1997 s. 0049 - 0049
 ETA:N SEKAKOMITEAN PÄÄTÖS N:o 16/97,tehty 26 päivänä maaliskuuta 1997,ETA-sopimuksen liitteen II (Tekniset määräykset, standardit, testaus ja varmentaminen) muuttamisesta ETA:N SEKAKOMITEA, jokaottaa huomioon Euroopan talousalueesta tehdyn sopimuksen, sellaisena kuin se on tarkistettuna mainitun sopimuksen tarkistamisesta tehdyllä pöytäkirjalla, jäljempänä `sopimus`, ja erityisesti sen 98 artiklan,sekä katsoo, ettäsopimuksen liitettä II on viimeksi muutettu ETA:n sekakomitean päätöksellä N:o 4/97 (1), jaEuroopan parlamentin ja neuvoston päätös N:o 3052/95/EY, tehty 13 päivänä joulukuuta 1995, tavaroiden vapaan liikkuvuuden periaatteesta yhteisössä poikkeavia kansallisia toimenpiteitä koskevan tietojenvaihtomenettelyn luomisesta (2) on otettava osaksi sopimusta,ON PÄÄTTÄNYT SEURAAVAA:1 artikla Lisätään sopimuksen liitteessä II olevan XIX luvun 3 e kohdan jälkeen (Euroopan parlamentin ja neuvoston direktiivi 94/11/ETY) kohta seuraavasti:"3f. 395 D 3052: Euroopan parlamentin ja neuvoston päätös N:o 3052/95/EY, tehty 13 päivänä joulukuuta 1995, tavaroiden vapaan liikkuvuuden periaatteesta yhteisössä poikkeavia kansallisia toimenpiteitä koskevan tietojenvaihtomenettelyn luomisesta (EYVL N:o L 321, 30.12.1995, s. 1)."2 artikla Päätöksen N:o 3052/95/EY islanniksi ja norjaksi laaditut tekstit, jotka on liitetty tämän päätöksen vastaavaan toisintoon, ovat todistusvoimaisia.3 artikla Tämä päätös tulee voimaan 1 päivänä huhtikuuta 1997, jos sopimuksen 103 artiklan 1 kohdan mukaan vaadittavat ilmoitukset on tehty ETA:n sekakomitealle.4 artikla Tämä päätös julkaistaan Euroopan yhteisöjen virallisen lehden ETA-osastossa ja ETA-täydennysosassa.Tehty Brysselissä 26 päivänä maaliskuuta 1997.ETA:n sekakomitean puolestaC. DAYPuheenjohtaja(1) Ks. tämän virallisen lehden sivu 32(2) EYVL N:o L 321, 30.12.1995, s. 1


text:
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 52008PC0302
 Pasiūlymas Tarybos reglamentas panaikinantis 2007 m. gegužės 30 d. Tarybos reglamentą (EB) Nr. 752/2007 dėl tam tikrų apribojimų, taikomų tam tikriems iš Ukrainos importuojamiems plieno gaminiams, administravimo /* KOM/2008/0302 galutinis - ACC 2008/0094 */
 [pic] | EUROPOS BENDRIJŲ KOMISIJA |Briuselis, 2008.5.13KOM(2008) 302 galutinis2008/0094 (ACC)PasiūlymasTARYBOS REGLAMENTASpanaikinantis 2007 m. gegužės 30 d. Tarybos reglamentą (EB) Nr. 752/2007 dėl tam tikrų apribojimų, taikomų tam tikriems iš Ukrainos importuojamiems plieno gaminiams, administravimo(pateikta Komisijos)AIŠKINAMASIS MEMORANDUMASEuropos Bendrijos ir Ukrainos prekyba tam tikrais plieno gaminiais buvo reglamentuojama susitarimu, kuriuo taip pat nustatoma Ukrainos kilmės plieno importo kvota. Kaip numatyta susitarimo 10 straipsnio 4 dalyje, Ukrainai įstojus į Pasaulio prekybos organizaciją susitarimas nutraukiamas, o kvota panaikinama. Numatyta įstojimo data yra 2008 m. gegužės 16 d. Todėl Komisija siūlo dabar panaikinti Reglamentą, kuriuo Bendrijoje įgyvendinamas susitarimas.Todėl Tarybos prašoma priimti Komisijos pateiktą pasiūlymą ir Oficialiajame leidinyje paskelbti reglamentą.2008/0094 (ACC)PasiūlymasTARYBOS REGLAMENTASpanaikinantis 2007 m. gegužės 30 d. Tarybos reglamentą (EB) Nr. 752/2007 dėl tam tikrų apribojimų, taikomų tam tikriems iš Ukrainos importuojamiems plieno gaminiams, administravimoEUROPOS SĄJUNGOS TARYBA,atsižvelgdama į Europos bendrijos steigimo sutartį, ypač į jos 133 straipsnį,atsižvelgdama į Komisijos pasiūlymą,kadangi:1. Europos Bendrijų bei jų valstybių narių ir Ukrainos partnerystės ir bendradarbiavimo susitarimas[1] (toliau − PBS) įsigaliojo 1998 m. kovo 1 d.2. PBS 22 straipsnio 1 dalyje nurodyta, kad prekybą tam tikrais plieno gaminiais reglamentuoja to susitarimo III antraštinė dalis, išskyrus jos 14 straipsnį, ir susitarimo dėl kiekybinių priemonių nuostatos.3. 2007 m. birželio 18 d. Europos bendrija ir Ukrainos vyriausybė sudarė susitarimą dėl prekybos tam tikrais plieno gaminiais[2] (toliau − susitarimas).4. 2007 m. gegužės 30 d. Taryba priėmė reglamentą (EB) Nr. 752/2007 dėl tam tikrų apribojimų, taikomų tam tikriems iš Ukrainos importuojamiems plieno gaminiams, administravimo[3], kuriuo būtų įgyvendinamas susitarimas.5. Susitarimo 10 straipsnio 4 dalyje nustatyta, jog, Ukrainai įstojus į Pasaulio prekybos organizaciją iki susitarimo galiojimo pabaigos, susitarimas nutraukiamas, o kiekybinės normos panaikinamos nuo įstojimo dienos.6. 2008 m. gegužės 16 d. Ukraina taps Pasaulio prekybos organizacijos nare.7. Tą dieną reglamentas, kuriuo įgyvendinamas susitarimas, netenka prasmės.8. Todėl, siekiant aiškumo, Reglamentą (EB) Nr. 752/2007 reikia panaikinti,PRIĖMĖ ŠĮ REGLAMENTĄ:1 straipsnisReglamentas (EB) Nr. 752/2007 panaikinamas.2 straipsnisŠis reglamentas įsigalioja kitą dieną po jo paskelbimo Europos Sąjungos oficialiajame leidinyje .Šis reglamentas privalomas visas ir tiesiogiai taikomas visose valstybėse narėse.Priimta Briuselyje [...]Tarybos varduPirmininkas [...] [1] OL L 49, 1998 2 19, p. 3.[2] OL L 178, 2007 7 6, p. 24.[3] OL L 178, 2007 7 6, p. 1.


text:
C 118/18 FI Euroopan yhteisöjen virallinen lehti 21.4.2001
 Tribunale di Brescian 20.1.2001 tekemällään päätöksellä Kantaja vaatii, että yhteisöjen tuomioistuin
 esittämä ennakkoratkaisupyyntö asioissa 1) Agricola Tor-
 riani s.a.s. 2) Finanziaria Immobiliare Perugino s.p.a. ja – kumoaa 21.12.2000 tehtyn komission päätöksen
 3) San Marco s.p.a. vastaan Ministero delle Finanze K(2000) 3565 lopull., joka koskee valtiontukea, jonka
 Italia aikoo myöntää Solar Tech Srl:lle, koska sen mukaan
 (Asiat C-88/01, C-89/01 ja C-90/01) tukeen ei voida soveltaa pieniä ja keskisuuria yrityksiä
 (PKY) koskevaa 15 prosentin määräistä bruttoavustuse-
 kvivalenttia (1), ja velvoittaa komission korvaamaan oi-
 (2001/C 118/28) keudenkäyntikulut.
 Tribunale di Brescia on pyytänyt 20.1.2001 tekemällään
 päätöksellä, joka on saapunut Euroopan yhteisöjen tuomiois- Oikeudelliset perusteet ja pääasialliset perustelut
 tuimen kirjaamoon 21.2.2001, Euroopan yhteisöjen tuomiois-
 tuimelta asioissa 1) Agricola Torriani s.a.s. 2) Finanziaria
 Italian hallitus väittää, että perustaessaan säädetyn korotuksen
 Immobiliare Perugino s.p.a. ja 3) San Marco s.p.a. vastaan
 hyväksymättä jättämistä koskevan päätöksen pienten ja keski-
 Ministero delle Finanze ennakkoratkaisua seuraaviin kysymyk-
 suurten yritysten (PKY) käsitteeseen, jossa ei oteta huomioon
 siin:
 yksinomaan PKY:lle myönnettäviä tukia koskevissa oikeus-
 säännöissä asetettuja edellytyksiä, komissio on rikkonut näitä
 1. Ovatko yhteisön oikeuden ja erityisesti 17.7.1969 anne- sääntöjä, joita yhteisöjen tuomioistuimen oikeuskäytännössä
 tun neuvoston direktiivin 69/335/ETY (1) 10 ja 12 artiklan on pidetty pakottavina.
 mukaisia 23.12.1998 annetun Italian lain nro 448 (GURI,
 29.12.1998, nro 302, supplemento ordinario) 11 §:n 1
 momentin kaltaiset säännökset, joiden mukaan ”yhtiöitä Italian hallitus väittää myös, että koska komissio on soveltanut
 koskevien muiden toimien” merkitsemisestä rekisteriin näitä sääntöjä riidanalaisessa päätöksessä, se on loukannut
 vuosina 1985–1992 suoritettava julkinen maksu (tassa myös luottamuksensuojan ja oikeusvarmuuden periaatteita.
 di concessione governativa) on suoritettava kiinteänä
 vuosimaksuna, joka on osake- ja kommandiittiyhtiöiden
 osalta 750 000 Italian liiraa ja rajavastuuyhtiöiden osalta (1) Bruttoavustusekvivalenttina ilmaistu yhdistetty todellinen tuki-
 400 000 Italian liiraa vuodessa? intensiteetti, joka määräytyy yrityksen koon ja tuotantoyksikön
 sijainnin perusteella.
 2. Ovatko yhteisön oikeuden mukaisia lain nro 448/98 11
 §:n 3 momentin kaltaiset säännökset, joiden mukaan kun
 on maksettu 1 momentissa tarkoitettua suurempi summa,
 lasketaan tästä johtuvalle palautukselle laillisia korkoja
 sen suuruisina kuin ne olivat sinä päivänä, jona tämä laki
 tuli voimaan (eli 2,5 prosenttia vuodessa) eikä 26.1.1961
 annetun lain nro 29 5 §:ssä, yhdessä sen 1 §:n kanssa ja
 sellaisena kuin se on myöhemmin muutettuna, tarkoite-
 tun koron suuruisena? Verwaltungsgerichtshofin 29.1.2001 tekemällään päätök-
 sellä esittämä ennakkoratkaisupyyntö valitusasioissa,
 joissa asianosaisina ovat 1. Gottfried Linhart ja 2. Dr. Hans
 (1) EYVL L 249, 3.10.1969, s. 25. Biffl
 (Asia C-99/01)
 (2001/C 118/30)
 Verwaltungsgerichtshof on pyytänyt 29.1.2001 tekemällään
 Italian tasavallan 21.2.2001 Euroopan yhteisöjen komis- päätöksellä, joka on saapunut yhteisöjen tuomioistuimen
 siota vastaan nostama kanne kirjaamoon 28.2.2001, Euroopan yhteisöjen tuomioistuimelta
 ennakkoratkaisua valitusasioissa, joissa asianosaisina ovat
 1. Gottfried Linhart ja 2. Dr. Hans Biffl seuraaviin kysymyksiin:
 (Asia C-91/01)
 1. Ovatko EY 28 ja EY 30 artikla sekä kosmeettisia valmistei-
 (2001/C 118/29) ta koskevan jäsenvaltioiden lainsäädännön lähentämisestä
 27 päivänä heinäkuuta 1976 (1) annettu neuvoston direk-
 tiivi 76/768/ETY, sellaisena kuin se on muutettuna neu-
 Italian tasavalta on 21.2.2001 nostanut kanteen Euroopan voston 21.12.1988 (2) antamalla direktiivillä 88/667/ETY
 yhteisöjen komissiota vastaan Euroopan yhteisöjen tuomiois- ja neuvoston 14.6.1993 (3) antamalla direktiivillä
 tuimessa. Kantajan asiamiehenä on Umberto Leanza, jota 93/35/ETY (jäljempänä direktiivi 76/768/ETY), ja erityi-
 avustaa valtionasiamies Danilo Del Gaizo. sesti sen 6 artiklan 3 kohta, samoin kuin harhaanjohtavaa


text:
 31.8.2013
 SK
 Úradný vestník Európskej únie
 C 252/14
 Odvolanie podané 24. mája 2013: Dole Company, Inc., Dole Fresh Fruit Europe Ltd & Co. proti rozsudku Všeobecného súdu (ôsma komora) zo 14. marca 2013 vo veci T-588/08, Dole Food Company, Inc., Dole Fresh Fruit Europe Ltd & Co./Európska komisia
 (Vec C-286/13 P)
 2013/C 252/22
 Jazyk konania: angličtina
 Účastníci konania
 Odvolateľky: Dole Company, Inc., Dole Fresh Fruit Europe Ltd & Co. (v zastúpení: J.-F. Bellis avocat)
 Ďalší účastník konania: Európska komisia
 Návrhy odvolateľky
 Odvolateľky navrhujú, aby Súdny dvor:
 —
 zrušil úplne alebo čiastočne napadnutý rozsudok v rozsahu, v akom zamieta žalobu odvolateliek,
 —
 zrušil úplne alebo čiastočne rozhodnutie Komisie z 15. októbra 2008 v rozsahu, v akom sa týka odvolateliek,
 —
 na základe neobmedzenej právomoci podľa článku 261 ZFEÚ zrušil alebo znížil pokutu uloženú odvolateľkám,
 —
 subsidiárne vrátil vec Všeobecnému súdu, aby rozhodol v súlade s rozhodnutím Súdneho dvora,
 —
 zaviazal Komisiu na náhradu trov tohto konania a trov konania pred Všeobecným súdom.
 Odvolacie dôvody a hlavné tvrdenia
 V prvom odvolacom dôvode, ktorý je rozdelený na päť častí, odvolateľky tvrdia, že Všeobecný súd sa pri preskúmaní dopustil viacerých procesných chýb:
 Všeobecný súd sa dopustil chyby, keď povolil Komisii sa v súdnom konaní po prvýkrát dôkaz zaoberať dôkazom v spise, ktorý je v rozpore so zisteniami v rozhodnutí,
 Všeobecný súd chybne zamietol prípustnosť dôkazu predloženého odvolateľkami zo spisu Komisie na vyvrátenie nového tvrdenia Komisie v duplike,
 Všeobecný súd chybne zamietol prípustnosť prílohy predloženej odvolateľkami na podporu ich tvrdenia, že Komisia vytrhla z kontextu ich vyhlásenia, ktoré urobili v čase správneho konania,
 Všeobecný súd porušil zásadu rovnosti v konaní, keď nezohľadnil dôkazy podané odvolateľkami v rámci súdneho konania a
 Všeobecný súd nezistil správne skutkové okolnosti.
 V druhom odvolacom dôvode odvolateľky tvrdia, že Všeobecný súd skreslil skutočnosti nevyhnutné na správne posúdenie sporného správania v jeho právnom a ekonomickom kontexte.
 V treťom odvolacom dôvode, ktorý je rozdelený na päť častí, odvolateľky tvrdia, že Všeobecný súd nedostatočne posúdil dôkazy:
 Všeobecnú súd nepredložil dostatočné dôvody na prijatie výšky trhových podielov uvádzaných Komisiou na účely vytvorenia príslušnej trhovej štruktúry,
 Všeobecný súd sa dopustil chyby, keď prišiel k záveru, že Komisia nie je povinná spresniť obsah rozhovorov odvolateliek s ostatnými podnikmi, ktoré predstavujú obmedzenie hospodárskej súťaže na základe cieľa,
 Všeobecný súd sa dopustil chyby, keď prišiel k záveru, že Komisia jasne opísala obsah rozhovorov odvolateliek s ostatnými podnikmi, ktoré predstavujú obmedzenie hospodárskej súťaže na základe cieľa,
 Všeobecný súd sa nezaoberal tvrdením odvolateliek, že niektorý zamestnanci nemohli poskytnúť dôveryhodné informácie,
 Všeobecný súd sa dopustil chyby, keď uplatnil nesprávne právne posúdenie skutočností a prišiel k záveru, že rozhovory predstavujú obmedzenie hospodárskej súťaže na základe cieľa.
 Vo štvrtom odvolacom dôvode, ktorý je rozdelený na dve časti, odvolateľky tvrdia, že Všeobecný súd sa pri výpočte uloženej pokuty dopustil viacerých chýb:
 Všeobecný súd sa dopustil chyby, keď počítal pokutu na základe predaja spoločností, u ktorých nebolo zistené porušenie a
 Všeobecný súd sa dopustil chyby, keď na účely výpočtu pokuty počítal predaj rovnakých výrobkov dvakrát.


text:
Kiryu (桐生市 -shi) é uma cidade japonesa localizada na província de Gunma.
 Em 2003 a cidade tinha uma população estimada em 112 690 habitantes e uma densidade populacional de 819,74 h/km2. Tem uma área total de 137,47 km2.
 Recebeu o estatuto de cidade a 1 de março de 1921.
 Cidades-irmãs
 Columbus, EUA
 Biella, Itália
 Naruto, Japão
 Hitachi, Japão
 Referências
 Ligações externas
 Site oficial em japonês