In part because of past shortcomings in a centralized database, the CMS and its contractors that administer the Medicare prescription-drug benefit have allowed more than $15 million worth of drugs to be dispensed to patients by doctors whose past criminal activity should have barred them from prescribing, according to a new report (PDF).
HHS: Some drugs prescribed by barred docs
HHS Inspector General Daniel Levinson's office audited all $185 billion in drugs that were prescribed during the first three years of the new prescription-drug benefit program, known in government circles as Medicare Part D, and found that a narrow share—less than 1%—was ordered by doctors prohibited from prescribing between 2006 and 2008.
Auditors pinpointed several inadequate internal controls that allowed at least $15.1 million in prohibited prescriptions to be dispensed to patients, including the CMS' past practice of not allowing its prescription-drug contractors access to a central database of prohibited prescribers. Auditors also criticized the HHS contractors' use of state indentifiers in screening databases instead of unique national provider identifier numbers.
In response, the CMS said it had rectified both problems, giving its contractors access to monthly updates about prohibited prescribers through its Medicare Exclusion Database, which now includes national provider numbers. However, former CMS Administrator Dr. Donald Berwick was more skeptical of auditors' suggestions to try to recoup the $15.1 million from contractors who should not have allowed the payments.
Berwick, writing in a Sept. 21 response to the draft audit, said the agency would have to reopen the final payment determinations for the contractors from 2006, 2007 and 2008 to recover any portions of the drugs paid for by Medicare, but it was not clear whether such a step would be cost-effective. The final audit with Berwick's comments was released today.
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