From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Wed, Aug 27, 2014 at 8:57 AM
Subject: OIG posts 3 reports and news about enforcement actions - 8/27
To: iammejtm@gmail.com
Good morning from Washington, DC. Today OIG posts 3 reports and news about enforcement actions. As always, you can use the links provided to go directly to the new material.
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The District of Columbia Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-03-12-00205) http://go.usa.gov/mfdz
The District of Columbia's Department of Health Care Finance (State agency) did not always comply with Federal Medicaid requirements for billing manufacturers for rebates for physician-administered drugs. The State agency properly billed for rebates for claim lines totaling $2.2 million in our judgmental sample. However, the State agency did not bill for rebates for claim lines totaling $4.3 million. Of this amount, we identified $3.1 million ($2.4 million Federal share) for which the State agency should have billed for rebates on claim lines for single-source and top-20 multiple-source drugs. Because the State agency did not capture National Drug Codes (NDCs) or did not bill the manufacturers for rebates, it improperly claimed Federal reimbursement for these claim lines. We were unable to determine the portion of the remaining $1.3 million ($983,000 Federal share) for which the State agency may have improperly claimed reimbursement. This amount included claim lines for drugs that were not top-20 multiple-source and claim lines for which there was insufficient information to determine whether the drugs were eligible for rebates. The State agency said that it did not capture NDCs or submit these claims for rebates because of many issues with its Medicaid Management Information System (MMIS) and rebate system. The State agency did not require that providers include NDCs on physician-administered drug claims until June 2008 and did not begin to bill for rebates until 2010. We recommended that the State agency:
(1) Refund to the Federal Government $2.3 million (Federal share) for single-source and top-20 multiple-source physician-administered drug claims that were ineligible for Federal reimbursement;
(2) Work with CMS to determine the unallowable portion of the $983,000 (Federal share) for other physician-administered drug claims that were ineligible for Federal reimbursement and refund that amount;
(3) Work with CMS to determine and refund the unallowable Federal reimbursement for physician-administered drugs claimed without NDCs after January 1, 2011;
(4) Ensure that its MMIS edits require valid NDCs for payment on all drug claims; and
(5) Improve its rebate processes to ensure that all physician-administered drug claims are submitted for rebates.
The State agency partially concurred with our first two recommendations and fully concurred with our remaining recommendations.
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New Jersey Claimed Unallowable Community Services Block Grant Costs Incurred by Check-Mate, Inc., Under the Recovery Act (A-02-11-02017) http://go.usa.gov/mfdP
New Jersey claimed unallowable Community Services Block Grant (CSBG) costs incurred by Check-Mate, Inc., under the Recovery Act totaling $246,000. This occurred because the State agency did not adequately monitor Check-Mate's expenditures to ensure that CSBG costs were allowable in accordance with applicable Federal requirements. We recommended that the State agency refund $246,000 to the Federal Government.
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Tyler Prosthetics, Inc., Generally Met Medicare Documentation Requirements for Lower Limb Prosthetic Claims (A-06-13-00049) http://go.usa.gov/mfpH
For the period January 1, 2012, through June 30, 2013, Tyler Prosthetics Inc. (located in Texas), inappropriately received Medicare payment for two lower limb prosthetic claims totaling $23,000.
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August 26, 2014; U.S. Department of Justice Owner of Home Health Care Company Sentenced to Nearly Six Years in Prison for Role in $6 Million Medicare Fraud Scheme http://go.usa.gov/NXZP
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August 26, 2014; U.S. Department of Justice Former Acting HHS Cyber Security Director Convicted for Engaging in Child Pornography Enterprise http://go.usa.gov/NXZP
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August 26, 2014; U.S. Attorney; Southern District of Texas DME Owner Heads to Prison for Multiple Counts of Health Care Fraud http://go.usa.gov/NXZP
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August 25, 2014; U.S. Attorney; Central District of California South Bay Doctor Pleads Guilty in Medicare Fraud Case, Admitting He Wrote Bogus Prescriptions for Power Wheelchairs and Other DME http://go.usa.gov/NXZP
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State Enforcement Actions Updated http://go.usa.gov/NXWh
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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
I hope your week is going well.
Marc Wolfson – Office of External Affairs
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Jeremy Tobias Matthews
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