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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-02-18-01011
Report Description

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program's drug rebate requirements, manufacturers must pay rebates to the States for the drugs. However, a prior OIG audit found that States did not always invoice and collect all rebates due for drugs administered by physicians.

Report Type
Audit
Location

NY
United States

Number of Recommendations
5
Questioned Costs
$6,399,243
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region2/21801011.asp
External Entity
State of New York

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268284 No $146,672 $0

We recommend that the New York Department of Health refund to the Federal Government $146,672 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

268285 No $0 $0

We recommended that the New York Department of Health work with CMS to determine the unallowable portion of $2,340,390 (Federal share) for other claims for covered outpatient physician-administered drugs that were submitted without NDCs and that may have been ineligible for Federal reimbursement and refund that amount, and whether the remaining $714,777 (Federal share) of other physician-administered drug claims could have been invoiced to the manufacturers to receive rebates and, if so, upon receipt of the rebates, refund the Federal share of the manufacturers’ rebates for those claims.

268283 No $3,197,404 $0

We recommend that the New York Department of Health refund to the Federal Government $3,197,404 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement

268286 No $0 $0

We recommended that the New York Department of Health work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2017.

268287 No $0 $0

We recommended that the New York Department of Health strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.

Department of Health & Human Services OIG

United States