Fwd: OIG posts 2 reports and news about enforcement actions - 7/22

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From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Tue, Jul 22, 2014 at 8:32 AM
Subject: OIG posts 2 reports and news about enforcement actions - 7/22
To: iammejtm@gmail.com

Good morning from Washington, DC. Today OIG posts 2 reports and news about enforcement actions. As always, you can use the links provided to go directly to the new material.   ------------------------------------------------------------------------------   The Rhode Island Medicaid Program Could Lower Payments for Selected Durable Medical Equipment and Supplies (A-01-13-00006) http://go.usa.gov/5Nqd   Rhode Island Medicaid could have saved approximately $1 million ($608,000 Federal share) on selected durable medical equipment incontinence items by limiting reimbursement to the most frequently reimbursed usual and customary charge amounts from July 2010 through June 2011.   ------------------------------------------------------------------------------   Limitations in Manufacturer Reporting of Average Sales Price Data for Part B Drugs (OEI-12-13-00040) http://go.usa.gov/5N3T   WHY WE DID THIS STUDY Manufacturer-reported average sales prices (ASPs) serve as the basis for most Part B drug payment amounts. Complete ASP data ensure that payment amounts are accurate and are reflective of all manufacturer sales prices. Previous OIG work has shown that CMS lacks complete ASP data for certain drugs because:   (1) Not all manufacturers that are required to report ASPs are doing so and   (2) Not all manufacturers of Part B drugs are required to report ASPs.   OIG has previously recommended that CMS consider seeking a legislative change to require all manufacturers of Part B drugs to submit ASPs. In response, CMS stated that it would be helpful if OIG provided a full analysis of the policy's implications.   HOW WE DID THIS STUDY We compared data in CMS's background and crosswalk files—the agency's two ASP related files—with two national drug compendia to determine the number of manufacturers that did not report required ASPs in the third quarter of 2012. We then determined the number of additional manufacturers that would be required to submit ASPs if reporting requirements were extended to all manufacturers of Part B drugs. We also identified national drug codes (NDCs) with incorrect product and pricing information in CMS's ASP files. Finally, we surveyed CMS officials and reviewed CMS policies to determine whether the agency has improved ASP collection and verification processes since the publication of OIG's prior work.   WHAT WE FOUND At least one-third of the more than 200 manufacturers of Part B drugs did not submit ASPs for some of their products in the third quarter of 2012, despite being required to do so. An additional 45 manufacturers of Part B drugs were not required to report ASPs that quarter. Furthermore, for a small number of drugs, inaccuracies in CMS's ASP files may have affected Medicare payments. Finally, CMS has improved its ASP-related processes and procedures; however, challenges remain.   WHAT WE RECOMMEND We recommend that CMS:   (1) Continue to assist OIG in identifying and penalizing manufacturers that do not meet ASP reporting requirements;   (2) Seek a legislative change to directly require all manufacturers of Part B drugs to submit ASPs;   (3) Ensure the accuracy of product information for NDCs listed in the background and crosswalk files; and   (4) Finalize the implementation of automated ASP-related procedures by using processes related to average manufacturer price as a model, and subsequently require all manufacturers to submit ASPs through the automated system.   CMS concurred with our first, third, and fourth recommendations, but did not concur with our recommendation to seek a legislative change.   ------------------------------------------------------------------------------   July 21, 2014; U.S. Department of Justice Alabama Hospital System and Physician Group Agree to Pay $24.5 Million to Settle Lawsuit Alleging False Claims for Illegal Medicare Referrals http://go.usa.gov/9SrT    ------------------------------------------------------------------------------   July 21, 2014; U.S. Attorney; District of Kansas Wichita Chiropractor Pleads Guilty In Health Care Fraud Case http://go.usa.gov/9SrT    ------------------------------------------------------------------------------   July 21, 2014; U.S. Attorney; Southern District of West Virginia Former West Virginia DHHR Employee Pleads Guilty To Fraud http://go.usa.gov/9SrT    ------------------------------------------------------------------------------   July 1, 2014; Office of Inspector General; U.S. Department of Health and Human Services Kentucky Health & Rehab Center Settles Case with OIG Involving Allegation of Employing Excluded Individual http://go.usa.gov/5N3A   ------------------------------------------------------------------------------   State Enforcement Actions Updated http://go.usa.gov/9Srm   ------------------------------------------------------------------------------   That's all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov   Make it a great day!   Marc Wolfson – Office of External Affairs   OIG's privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp Follow us on Twitter: http://twitter.com/OIGatHHS Inquiries? Contact us: Public.Affairs@oig.hhs.gov Manage your OIG subscriptions: update your preferences or unsubscribe Questions about this service? Visit subscriberhelp.govdelivery.com This email was sent to iammejtm@gmail.com using GovDelivery, on behalf of the U.S. Dept. of Health & Human Services · 200 Independence Avenue SW · Washington DC 20201 · 1-877-696-6775

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Jeremy Tobias Matthews