OIG: Investigations Recovered $26B in FY2010

Cheryl Clark, for HealthLeaders Media , December 17, 2010

• Medicare drug plans and enrollees paid pharmacies $1.2 billion in 2007 for more than 18 million prescription drug claims that contained 527,749 invalid prescriber identifiers. The claims lacked valid National Provider Identifier, Drug Enforcement Administration, or Unique Physician Identification number, or used numbers that had been deactivated before Jan. 1, 2006.

Additionally, Medicare drug plans and enrollees paid $237 million for these drugs.  And, just one of the "top 10 invalid prescriber identifier numbers was recorded on almost 1.8 million prescription drug event (PDE) records for more than 150,000 beneficiaries enrolled with 248 different Medicare drug plan sponsors.

• For calendar years 2006 and 2007, Medicare paid $43.3 million for less-than-effective drugs because the Part D program used an incomplete list of these drugs." These are drugs that Medicare approved before 1962 and for which the U.S. Food and Drug Administration has determined to be "less than effective."  Also, the OIG criticized CMS because there is no definitive list of these drugs, although CMS said the responsibility belonged to the FDA.
For Medicaid, the OIG found problems with delivery of services for eligible children in nine states, most of whom who were not fully benefitting from the program's Early and Periodic Screening, Diagnostic and Treatment comprehensive screening services. "We found that 76% of children in these states, or 2.7 million children, did not receive all of the required number of medical, vision and hearing screenings," the report said.

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