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Prescription drug problem must be fixed

April 23, 2013
The Mining Journal

A story on page 1C in today's Mining Journal published under the headline "Phantom scripts" details one of those governmental problems that has an apparent resolution but because governmental bureaucracies are made up of people, getting things fixed might not be easy.

According to a review by the Auditor General's Office, the state of Michigan in recent years shelled the better part of $1 million for prescriptions written by dead or otherwise inelligible health care providers between October 2009 and June 2012.

The bogus payments, and there thousands of them, came through the Medicaid program, for which the state is reimbursed the federal government.

Overall, the federal government reinbursed the state of Michigan $1.7 billion during the period for prescription drugs, so the amounts at issue represent represent the proverbial drop in the bucket.

That said, these are funds that could have been used for legitimate purposes and nd in this day and age, every dollar counts.

The problem, according to the records review, relates to the Michigan Department of Community Health not notifying the Medicaid pharmacy benefits manager, Magellan Health Services Inc., headquartered in Connecticut, of the death of 82 providers during the past three years. That cost the state $89,010 to reimburse ineligible claims to 324 pharmacies.

And that's just for openers. The state also reimbursed pharmacies $712,000 for 16,818 Medicaid claims from prescriptions written by 33 providers who had their privileges suspended or revoked between October 2009 and April 2012.

Apparently, DCH didn't consistently notify pharmacies of sanctioned providers and it didn't have adequate controls to prevent unauthorized prescriptions from being filled.

The review did not detail what types or classifications of drugs were dispensed in the fraudalent transactions.

The solution to all of this is easy, relatively speaking: The appropriate people and agencies have to talk to one another in meaningful ways. Notifications must be made promptly and all relevant parties brought into the discussion.

We wonder if it will happen.

 
 

 

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