OIG says Colorado falsely claimed $6.5 mil­lion in Med­i­caid pay­ments

Modern Healthcare - - REGIONAL NEWS - —Maria Castel­lucci

The state of Colorado falsely claimed $6.5 mil­lion in Med­i­caid re­im­burse­ment over three years af­ter it failed to com­ply with drug re­bate reg­u­la­tions.

HHS’ Of­fice of In­spec­tor Gen­eral found that the Colorado Depart­ment of Health Care Pol­icy and Fi­nanc­ing didn’t prop­erly fol­low re­quire­ments un­der the Med­i­caid drug re­bate pro­gram from 2010 to 2012. For out­pa­tient drugs to be el­i­gi­ble for re­im­burse­ment, man­u­fac­tur­ers must en­ter into re­bate agree­ments with the CMS. The state is re­quired to in­voice man­u­fac­tur­ers for the re­bates and sub­mit data on drug use.

Ac­cord­ing to the OIG, Colorado didn’t in­voice man­u­fac­tur­ers for re­bates to­tal­ing $13 mil­lion in el­i­gi­ble physi­cian-ad­min­is­tered drugs, $6.5 mil­lion of which was fed­eral dol­lars. The OIG said Colorado should re­fund that money. A spokesman for the Colorado Depart­ment of Health Care Pol­icy and Fi­nanc­ing said the depart­ment doesn’t agree with the OIG’s au­dit find­ings and is work­ing to in­voice all re­bate-el­i­gi­ble drugs so no funds will need to be re­im­bursed to the CMS.

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