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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-02-18-01016
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 audits 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
Location

NY
United States

Number of Recommendations
3
Questioned Costs
$10,885,620
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region2/21801016.asp
External Entity
State of New York

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268564 No $0 $0

We recommend New York State Department of Health 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 $3,039,473 (Federal share) of rebates collected.

268565 No $0 $0

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

268563 No $7,846,147 $0

We recommend that New York State Department of Health bill for and collect from manufacturers rebates for single-source and top-20 multiple-source pharmacy and physician-administered drugs and refund the estimated $7,846,147 (Federal share).

Department of Health & Human Services OIG

United States