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OIG: Medicare reimbursing practices too much for cancer drugs

Physician Practice Advisor, November 2, 2005

In a letter and report sent to the Senate in September, Inspector General Daniel Levinson concluded that some physician practices could purchase cancer treatment drugs for less than the reimbursement rates established by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA).

The results of an Office of the Inspector General (OIG) analysis show that practices in hematology, hematology/oncology, and medical oncology are being paid too much for the drugs.

"We based this conclusion on a statistical estimate of average prices paid by physician practices for 39 payment codes that constituted more than 94 percent of the $4.5 billion in total 2004 Medicare-allowed amounts for drugs associated with these 3 specialties. We also based the conclusion on a statistical estimate of the percentage of practice months for which physician practices were able to purchase drugs at less than the reimbursement amount," wrote Levinson.

To view the OIG report, click here.

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