HHS' Office of Inspector General on Tuesday said Medicare Part D paid for drugs that should have been paid for under the Medicare Part A hospice benefit, costing the federal government an additional $161 million.
The figure stemmed from the amount Part D paid for drugs that hospice organizations should have paid for under Part A, according to the new report. It's likely hospices should have paid for much of the remaining $262 million of the $423 million audited total drug costs, even though hospices told OIG they should not be responsible for that sum.
The report recommended that the CMS ensure hospices provide drugs covered under the hospice benefit by working with them directly. OIG also suggests that the CMS create and implement a strategy to ensure it doesn't double pay in the future.
"CMS must do more to avoid paying twice for the same drugs," the report said.
The National Hospice and Palliative Care Organization in a statement agreed with OIG that hospice providers are responsible for drugs treating terminal illness and related conditions, but noted there may be instances where patients or Medicare Part D pays for those treatments.
Most hospices didn't provide drugs because they didn't know that the drugs were prescribed by an outside physician or filled by an outside pharmacy, the OIG said. The second-most common response was that hospices didn't provide a reason or could not determine why they didn't pay for drugs.
The CMS said in comments on the draft report that its ongoing efforts to curb the duplicate payments problem are adequate and will avoid disrupting beneficiaries' access.
OIG disagreed, noticing "the duplicate payments persist," even after they addressed the issue in a 2012 report.
In a recently published rule concerning the hospice wage index and hospice quality reporting requirements, the CMS said that it intends to work with hospices and Part D plans to create a prior authorization process that can be used at the point-of-service when hospice beneficiaries are filling drug prescriptions.
The agency said this would reduce the risk of Medicare paying twice for drugs and that hospice beneficiaries would have to pay unnecessary out-of-pocket expenses stemming from improper payments for hospice drugs under Part D.
This is just one of several measures the federal government is taking to reduce how much taxpayers and consumers pay for drugs. The Senate is set to take up a major drug-pricing bill this fall.