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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-02-16-01011
Report Description

For a covered outpatient drug to be eligible for Federal Medicaid reimbursement, the manufacturer must enter into a rebate agreement administered by the Centers for Medicare & Medicaid Services (CMS) and pay quarterly rebates to the States. Previous OIG reviews found that States did not always bill and collect all rebates due for drugs administered by physicians to enrollees of Medicaid managed-care organizations (MCOs).

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
5
Questioned Costs
$195,091,864
Additional Details
https://oig.hhs.gov/oas/reports/region2/21601011.asp

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
267346 No $28,103,346 $0

We recommend that the State agency bill for and collect from manufacturers rebates for single-source and top-20 multiple-source pharmacy and physician-administered drugs and refund to the Federal Government the estimated $28,103,346 (Federal share).

267347 No $0 $0

We recommend the State agency work with CMS to determine whether the other pharmacy and physician-administered drugs were eligible for rebates and, if so, upon receipt of the rebates, refund up to an estimated $47,426,944 (Federal share) our audit period and $119,561,574 (Federal share) for the nearly 4-year period before our audit period.

267350 No $0 $0

We recommend that the State agency ensure that all pharmacy and physician-administered drugs eligible for rebates are processed for rebates.

267349 No $0 $0

We recommend that the State agency develop and implement written policies and procedures for its drug rebate program.

267348 No $0 $0

We recommend that the State agency strengthen its NDC edit (implemented on January 1, 2015), to ensure that NDCs are captured for all drug utilization data.

Department of Health & Human Services OIG

United States