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Regulatory Focus™ > News Articles > 2019 > 8 > HHS OIG to CMS: Avoid Paying Twice for the Same Drugs

HHS OIG to CMS: Avoid Paying Twice for the Same Drugs

Posted 27 August 2019 | By Zachary Brennan 

HHS OIG to CMS: Avoid Paying Twice for the Same Drugs

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) on Tuesday issued a report calling on the Centers for Medicare & Medicaid Services (CMS) to “do more to avoid paying twice for the same drugs.”

The OIG found that Medicare Part D paid for drugs during 2016 that hospices should have paid for under the Medicare Part A hospice benefit. “On the basis of our sample results, we estimated that the Part D total cost was $160.8 million for drugs that hospice organizations should have paid for,” OIG said.

Similarly, in June 2012, OIG issued a report to CMS indicating that during 2009, Medicare Part D paid $33.6 million and hospice beneficiaries paid $3.8 million for prescription drugs that likely should have been paid for by hospice organizations.

In the latest OIG audit, hospices said they should have paid for the drugs associated with 86 of the 200 Part D records that OIG investigated. As a result, the Medicare program paid twice for these drugs—once under the Part A hospice benefit and again under Part D, according to OIG.

“CMS has not developed or required controls to ensure that Part D is not paying for hospice-covered drugs,” OIG said.

In its recommendations, OIG called on CMS to work directly with hospices and to develop and execute a strategy to ensure that Part D does not pay for drugs that should be covered by the Part A hospice benefit.

CMS responded to OIG’s draft report, saying: “While CMS agrees with the importance to avoid duplicate payments to Medicare Part D drug plan sponsors and hospices, we maintain that CMS’s current efforts will address the issue and help ensure there is no disruption in beneficiary access.”

But OIG responded to that comment, saying: “Although we acknowledge CMS’s current efforts, we disagree that these efforts will address the issue of duplicate payments for hospice-covered drugs without a strategy that includes controls to identify and stop duplicate payments.”


Tags: CMS, HHS, hospice, OIG

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