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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
Components
Centers for Medicare and Medicaid Services
Report Number
A-04-21-08090
Report Type
Audit
Location

AL,
United States

Number of Recommendations
6
Questioned Costs
$15,457,223
Funds for Better Use
$0
External Entity
Alabama Medicaid Agency

Open Recommendations

This report has 6 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
23-A-04-118.01 No $14,960,673 $0

We recommend that the Alabama Medicaid Agency refund to the Federal Government $14,960,673 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.

23-A-04-118.02 No $43,981 $0

We recommend that the Alabama Medicaid Agency refund to the Federal Government $43,981 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

23-A-04-118.03 No $290,455 $0

We recommend that the Alabama Medicaid Agency work with CMS to determine and refund the unallowable portion of $290,455 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement and consider invoicing drug manufacturers for rebates for those drug claims that CMS determines are allowable.

23-A-04-118.04 No $162,114 $0

We recommend that the Alabama Medicaid Agency complete the process for rebating pharmacy drugs totaling $6,568 ($4,719 Federal share) for single-source and $219,220 ($157,395 Federal share) for multiple-source drugs that it had not previously collected a rebate on or refund the Federal share.

23-A-04-118.05 No $0 $0

We recommend that the Alabama Medicaid Agency 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, 2019.

23-A-04-118.06 No $0 $0

We recommend that the Alabama Medicaid Agency strengthen its internal controls to ensure that all pharmacy and physician-administered drugs eligible for rebates are invoiced.

Department of Health & Human Services OIG

United States