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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-07-19-06086
Report Description

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program’s drug rebate requirements, manufacturers must pay rebates to the States for the drugs. However, a prior OIG review found that States did not always invoice and collect all rebates due for drugs administered by physicians.Our objective was to determine whether Vermont complied with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs.

Report Type
Audit
Location

VT,
United States

Number of Recommendations
5
Questioned Costs
$405,095
Funds for Better Use
$0

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
269468 No $357,706 $0

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access refund to the Federal Government $357,706 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.

269469 No $47,389 $0

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access refund to the Federal Government $47,389 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

269470 No $0 $0

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access • work with CMS to determine the unallowable portion of $78,363 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable.

269471 No $0 $0

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access 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, 2017.

269477 No $0 $0

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.

Department of Health & Human Services OIG

United States