Skip to main content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Montana Correctly Claimed Federal Reimbursement for Most Medicaid Physician-Administered Drugs

Although the Montana Department of Public Health and Human Services (State agency) generally complied with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs, it claimed unallowable Federal reimbursement for some of these drugs. The State agency did not invoice manufacturers for rebates associated with $24,000 ($16,000 Federal share) in physician-administered drugs. Of this amount, $19,000 ($13,000 Federal share) was for single-source drugs, and $5,000 ($3,000 Federal share) was for top-20 multiple-source drugs. Because the State agency's internal controls did not always ensure that it invoiced manufacturers to secure rebates, the State agency improperly claimed Federal reimbursement for these single-source drugs and top-20 multiple-source drugs.

Further, the State agency did not submit the utilization data necessary to secure rebates for all other physician-administered drugs. Although the State agency generally collected the drug utilization data necessary to invoice the manufacturers for rebates associated with these claims, providers submitted claims totaling $128,000 ($85,000 Federal share) that did not have national drug codes (NDCs). We were unable to determine whether the State agency was required to invoice for rebates for these other physician-administered drug claims that did not have NDCs in the utilization data. Furthermore, under the Medicaid drug rebate program, claims totaling $47,000 ($31,000 Federal share), which contained NDCs, could have been eligible for rebates.

Filed under: Center for Medicare and Medicaid Services