The Centers for Medicare & Medicaid Services (CMS) has allowed physicians who are barred from prescribing under Medicare Part D to prescribe more than $15 million worth of drugs, according to the Office of the Inspector General (OIG).
On top of that, CMS accepted nearly $2 million for prescriptions that may have been written by providers excluded from Medicare part D because of past criminal offenses, according to a new OIG audit of prescription drug event data from 2006 through 2008.
Inadequate internal controls enabled excluded providers to prescribe millions of dollars in drug benefits. For example, CMS accepted state license numbers as prescriber identifiers instead of unique national provider identifiers. The agency also failed to establish an edit to reject prescription drug event data written by barred providers.
To recover the $15 million in improper payments, the OIG recommends CMS reopen final payment determinations from 2006 to 2008 and eliminate prescriptions written by providers excluded from Medicare Part D.
In response to the audit, CMS said it began giving monthly Medicare Exclusion Database updates, which include national provider identifiers, to private prescription drug and Medicare Advantage plans in July 2011.
However, OIG urges CMS to ensure the Medicare Exclusion Database includes all of the identifiers associated with every excluded provider in order for private prescription drug and Medicare Advantage plans to accurately identify those providers that have been barred from the program.
To learn more:
- read the OIG report (.pdf)
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Thank You Fierce Healthcare and Ms Caramenico