An audit found that a local Rite Aid overcharged Medicaid by nearly $200,000.
During an audit of the Rite Aid pharmacy located at 650 East Tremont St. in the Bronx, the New York State Office of the Medicaid Inspector General (OMIG) discovered irregularities in billings for prescriptions for Medicaid recipients, leading to projected overpayments of more than $193,275.
According to OMIG, the Rite Aid audit revealed them billing for a different drug than ordered by the prescriber, refilling a prescription more than 180 days after it was initiated by the prescriber and refilling a prescription in excess of the prescriber’s authorization. These practices all violate Medicaid regulations. Some of the other findings included instances where the ordering prescriber differed from the prescriber named on the claim and billings for which a prescription was missing.
The audit covered five years of Medicaid-funded services.
In a statement, Medicaid Inspector General James C. Cox said that New Yorkers shouldn’t be held financially responsible for others’ fraudulent practices.
“All providers who participate in the Medicaid program are expected to follow its rules and regulations,” said Cox. “Taxpayers should not be footing the bill for these excesses and discrepancies.”
This recent audit is part of OMIG’s battle against fraud, waste and abuse in the Medicaid program. According to a preliminary audit, in the first six months of 2013 alone, OMIG identified over $100 million in Medicaid overpayments. The OMIG’s audit over the first six months also revealed that actual cash recoveries increased as well during the same period by 21.5 percent over the previous year to $61.7 million.
Cox talked about finding these violations of Medicaid law while working with a smaller staff.
“At the end of state fiscal year 2011-12, OMIG had 662 staff members,” said Cox. “As of the end of the last state fiscal year (2012-13), OMIG has 500 employees. We are doing more with less.”
OMIG’s believes that audits such as the one recently completed at the Rite Aid pharmacy in the Bronx are an important component of their overall effort to fight fraud and recover improper payments in the Medicaid program.
“One of the Medicaid program’s goals is to provide excellent health care at a cost that taxpayers can afford,” said Cox. “Our work helps to contain costs while improving health care access and quality for Medicaid consumers.”
The final report (#09-5096) can be found under the “Final Audit Report” section on at www.omig.ny.gov.