An investigation by the Inspector-General (IG) at the U.S. Department of Health and Human Services (HHS) found evidence that Medicare is paying twice for multiple drugs prescribed for hospice patients.
If that is the case, it also means patients are paying co-pays twice for the same prescriptions. But Medicare officials – who assisted the IG investigation on the issue – deny that there is such a double-billing problem.
In its report, the IG explained that Medicare Part D officials paid for prescriptions for drugs used to combat nausea, anxiety, COPD and ALS that should have instead be covered by Medicare Part A.
“As a result, the Medicare program could be paying twice for prescription drugs for hospice beneficiaries: once under the Medicare Part A hospice per diem payments and again under Medicare Part D. Hospice beneficiaries could also be unnecessarily paying copayments for prescription drugs under Part D,” the IG report said.
“We identified 198,543 hospice beneficiaries who received 677,022 prescription drugs through the Medicare Part D program that potentially should have been covered under the per diem payments made to hospice organizations. Part D paid pharmacies $33,638,137 for these prescription drugs, and beneficiaries paid $3,835,557 in co-payments.”
When the IG contacted five of the plans participating in Medicare Part D, they found none had procedures in place to prevent such double payments.
So one of the IG’s recommendations to the Centers for Medicare and Medicaid (CMS) was that officials there develop procedures to prevent the double-payments.
That’s where CMS disagreed, according to the IG, “saying CMS did not concur with our second recommendation that it perform oversight to ensure that Part D is not paying for drugs that Medicare has already covered under the per diem payments made to hospice organizations.”
Why? Because “CMS stated that it would need conclusive evidence that there is such an issue before making payment adjustments and that implementing our methodology for an ongoing oversight program would be difficult and costly,” the IG said.
Perhaps with tongue in cheek, the IG report noted that “our methodology was complex, but CMS and hospice industry officials endorsed it and assisted us in its development. Our prior audit work, in which we worked with hospice medical and pharmacy staff, proved that duplicate payments were made.”
You can read the full IG report here.