Report Materials
For fiscal years 2004 and 2005, Illinois claimed $108,000
in Medicaid reimbursement for drugs that were no longer eligible for
reimbursement.
The
Medicaid drug
rebate program generally pays for covered outpatient drugs if their
manufacturers have rebate agreements with Centers for Medicare & Medicaid
Services (CMS) and pay rebates to the States. Under the drug rebate program,
CMS provides the States with a quarterly Medicaid drug tape, which the States
use to verify coverage of the drugs for which they claim reimbursement.
An additional $3.5 million represented expenditures for drug products that were
not listed on the quarterly drug tapes. Because the State did not verify
whether these drugs were eligible for coverage, these expenditures may not have
been allowable. We identified no other errors for the remainder of the $1.9
billion (Federal share) that the State claimed.
We recommended that the State (1) refund $108,000 to the Federal Government
for drug expenditures that were not eligible for Medicaid coveragework with CMS to resolve
$3.5 million
in payments for drugs that were not listed on the quarterly drug tapes and that may not have been eligible for Medicaid coverageand (3)
strengthen internal controls to ensure that claimed Medicaid drug expenditures
comply with Federal requirements. The State agreed with the first two
recommendations and disagreed with the third recommendation.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.