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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-06-17-04001
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
Location

TX
United States

Additional Details
https://oig.hhs.gov/oas/reports/region6/61704001.asp

Open Recommendations

This report has 4 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
267420 No $0 $0

We recommend that the Texas Health and Human Services Commission work with CMS to determine whether the other physician-administered drugs, associated with 160,579 claim lines, were eligible for rebates and, if so, determine the rebates due and upon receipt of the rebates refund the Federal share of the rebates collected.

267400 No $2,202,921 $0

We recommend that the Texas Health and Human Services Commission bill manufacturers for the $3,785,737 ($2,202,921 Federal share) in rebates for single-source and top-20 multiple-source physician-administered drugs, and refund the Federal share of rebates collected.

267421 No $363,241 $0

We recommend that the Texas Health and Human Services Commission work with CMS to determine whether the non-top-20 multiple-source physician-administered drugs were eligible for rebates and, if so, bill manufacturers for the $629,967 ($366,578 Federal share) in rebates and refund the Federal share of rebates collected.

267401 No $0 $0

We recommend that the Texas Health and Human Services Commission strengthen internal controls to ensure that all eligible physician-administered drugs are billed for rebate.

Department of Health & Human Services OIG

United States