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Review of Medicare Part D Prescription Drug Event Data for Schedule II Drugs at Health Net, Inc.

Health Net, Inc., did not have adequate controls to (1) prevent refills and unallowable partial fills of Schedule II drugs and (2) ensure the accuracy of certain fields in the Prescription Drug Event (PDE) records submitted for Schedule II drugs from January 2008 through June 2010, as required by Federal regulations. We found that 7 of 49 judgmentally selected PDE records represented unallowable partial fills (there were no refills), and 32 of 67 judgmentally selected PDE records contained inaccurate data when compared with the supporting documentation at the pharmacies.

Filed under: Center for Medicare and Medicaid Services