CMS Behind In Medicare Pricing Audits That Help Federal Government Prevent Pricing Fraud, GAO Report Finds

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Litigation / Medical Malpractice;  Pharma Industry / Biotech Industry
Article Date: 03 Nov 2008 - 6:00 PDT

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CMS has not completed the majority of its scheduled audits of 2006 drug pricing information, which could hinder the government in recognizing and preventing pricing fraud in the Medicare prescription drug benefit, according to a Government Accountability Office report released on Friday, CongressDaily reports. In order to ensure the Medicare Part D program receives the discounts or rebates insurers or pharmacy benefit managers negotiate with pharmaceutical companies, CMS is required to review pricing data for private insurers that participate in the Medicare drug benefit.

The agency received the data for the audits in July 2007 and will complete half of the 169 audits this month, according to the GAO report. CongressDaily reports that CMS is scheduled to finish the remaining audits by October 2009. In addition, the report stated that CMS has received only one completed audit. According to CMS, the second half of the auditing process was delayed because of budget constraints.

In a letter to GAO, CMS Acting Administrator Kerry Weems wrote that Medicare officials requested $118 million in fiscal year 2007 and $183 million in FY 2008 to fund the oversight program but that Congress did not enact the requests. House Oversight and Government Reform Committee Chair Henry Waxman (D-Calif.) said that he is disappointed with the delay and that his committee will continue to investigate waste and inefficiencies in the Medicare Part D program. Medicare officials do not expect the 2007 audits to be delayed, according to CongressDaily (Edney, CongressDaily, 10/30).

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