OIG reviews Medicaid outpatient drug expenditures in Montana
Healthcare Auditing Weekly, January 29, 2008
A small percentage of Medicaid outpatient drug expenditures in Montana for fiscal years 2002 through 2004 were not eligible for Medicaid coverage, an OIG audit found.
Of the $198 million claimed for reimbursement, $992,440 was for drugs that did not meet the requirements for reimbursement. They were either terminated drugs for which the termination dates were listed on the CMS quarterly drug tape before the drugs were dispensed or inadequately supported compound drug expenditures. An additional $363,210 represents expenditures for drug products that were not listed on the quarterly drug tapes and may not have been eligible for Medicaid coverage.
The OIG recommended Montana's Medicaid agency:
- Refund $992,440 to the federal government for drug expenditures that were not eligible for Medicaid coverage
- Work with CMS to resolve $363,210 in payments for drugs that were not listed on the quarterly drug tapes
- Strengthen internal controls to ensure that claimed Medicaid drug expenditures comply with federal requirements
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