At a time when both federal and state governments are struggling to pay their bills, a new government report by the Department of Health and Human Services Office of Inspector General (OIG) reveals that Medicare has improperly paid out millions of dollars for prescription drugs provided to incarcerated prisoners.  Prisoners are generally ineligible for federal health care benefits, including Medicare Part D, and their prescription needs are supposed to be paid by prison funds.

It’s certainly not the first time that these improper payments to drug providers have occurred.  An earlier government report detailed how $33.6 million was improperly paid from 2009 to 2011 to prisoners receiving medical treatment under Medicare Parts A, B, and D.  OIG said that Medicare Part D had accepted without further verification requests for prescription drug payment reimbursement submitted through sponsor or private plans, resulting in $12 in outlays for prisoners from 2006 to 2010.

According to the recent report, “Centers for Medicare and Medicaid Services (CMS) inappropriately accepted Prescription Drug Event Records (PDE) submitted by sponsor for prescription drugs provided to incarcerated beneficiaries and used those records to make its final payment determination.  Specifically, for 49 of the 100 beneficiaries that were sampled, CMS accepted 1,298 PDE records submitted by sponsors for prescription drugs provided to incarcerated beneficiaries.  The gross drug cost associated with these 1,298 accepted PDE records totaled $325,904.”

The report continued: “On the basis of our sample results, we estimated that CMS accepted PDE records with gross drug cost totaling an additional $11,656,314 for incarcerated beneficiaries.”  OIG said that the problem arose when CMS did not verify whether or not the person receiving the prescription drug benefits was incarcerated at the time they received the benefit, highlighting the problem that the federal government computer systems have in coordinating their information.

The federal Bureau of Prison (BOP) has previously been criticized by other federal agencies, including the Internal Revenue Service, for failing to share prisoner information, a failing BOP blames on privacy concerns.  However, a public BOP website contains the names, ages, and physical location of all prisoners in BOP custody.

The OIG made several specific recommendations for improvements that might prevent future incorrect reimbursements, including strengthening internal accounting control, as well as reopening, identifying, and perhaps even recovering some of the improper payments from the agencies that submitted the requests for reimbursement.

See: http://oig.hhs.gov, http://www.webpronews.com

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