State claimed ineligible drugs for Medicaid reimbursement
Healthcare Auditing Weekly, July 1, 2008
In fiscal years 2003 and 2004, Missouri claimed $2.09 billion ($1.33 billion in federal share) for reimbursement of Medicaid outpatient drug expenditures. However, the OIG found that the state did not fully comply with federal requirements.
According to the report, the OIG determined that $2,937,056 (federal share) represented expenditures for drug products that were not eligible for Medicaid coverage because they were either had termination dates listed on the CMS quarterly drug tape before the drugs were dispensed; or inadequately documented. An additional $1,887,845 (federal share) of the state’s claims were for drug products that were not on the quarterly drug tapes. These drugs may not have been allowable for Medicaid reimbursement.
The OIG is recommending the state:
- Refund $2,937,056 to the federal government for drug expenditures that were ineligible for Medicaid coverage;
- Work with CMS to resolve $1,887,845 in payments for drugs that were not listed on the quarterly drug tapes and may have been ineligible;
- Strengthen internal controls to ensure future Medicaid compliance by
- Claiming expenditures only for drugs dispensed before the termination dates listed on the quarterly tapes
- Maintaining documentation that supports the expenditure
- Verifying whether drugs not listed on the drug tapes are covered and notifying CMS when drugs are missing from the tapes
The state disagreed with the OIG’s findings.
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