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Audit (A-04-11-07024)

06-27-2014
Florida Made Some Payments for Pharmacy Items That Excluded Providers Had Prescribed

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Summary

The State agency made some payments for pharmacy items that excluded providers had prescribed, resulting in overpayments totaling $180,000 ($100,000 Federal share). These overpayments occurred because the State agency had inadequate policies and procedures to ensure that no payments were made for pharmacy items excluded providers had prescribed. Furthermore, the State agency may have paid up to $2.7 million to providers for pharmacy items prescribed by excluded providers because invalid information was included in the prescribing provider identified (ID) field. This invalid information occurred because the State agency had inadequate policies and procedures to ensure that valid prescribing provider IDs were included on submitted pharmacy claims before it paid them. As a result, the State agency may have paid up to $2.7 million to providers for pharmacy items that excluded providers had prescribed.

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