Report Materials
For fiscal years 2003 and 2004, Missouri claimed $2.9 million in Medicaid reimbursement for prescription drugs that were no longer eligible for reimbursement or inadequately documented. 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 $1.9 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 $2.09 billion ($1.33 billion Federal
share) that the State claimed.
We recommended that the State (1) refund $2.9 million to the Federal Government
for drug expenditures that were not eligible for Medicaid coverage, (2) work with CMS to resolve
$1.9 million
in payments for drugs that were not listed on the quarterly drug tapes and that may not have been eligible for Medicaid coverage, and (3)
strengthen internal controls to ensure that claimed
Medicaid drug expenditures comply with Federal requirements. The State
disagreed with our findings and recommendations.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.