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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-07-18-06078
Report Description

Connecticut did not always comply with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs. Connecticut did not invoice manufacturers for rebates associated with $1.1 million (Federal share) in physician-administered drugs. Of this amount, $1.07 million was for single-source drugs, and $46,210 was for top-20 multiple-source drugs. Further, Connecticut did not submit the utilization data necessary to secure rebates for all other physician-administered drug claims totaling $2.8 million (Federal share).

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
6
Questioned Costs
$1,111,597
Additional Details
https://oig.hhs.gov/oas/reports/region7/71806078.asp

Open Recommendations

This report has 6 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
267262 No $0 $0

We recommend that the Connecticut Department of Social Services work with CMS to determine the unallowable portion of $2,380,355 (Federal share) for other claims for outpatient physician-administered drugs that were submitted without NDCs or with invalid NDCs and that may have been ineligible for Federal reimbursement and refund that amount.

267260 No $1,065,387 $0

We recommend that the Connecticut Department of Social Services refund to the Federal Government $1,065,387 (Federal share) for claims for singlesource physician-administered drugs that were ineligible for Federal reimbursement.

267264 No $0 $0

We recommend that the Connecticut Department of Social Services 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, 2016.

267265 No $0 $0

We recommend that the Connecticut Department of Social Services strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.

267261 No $46,210 $0

We recommend that the Connecticut Department of Social Services refund to the Federal Government $46,210 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

267263 No $0 $0

We recommend that the Connecticut Department of Social Services work with CMS to determine whether the remaining $387,761 (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.

Department of Health & Human Services OIG

United States