The OIG recently released a report entitled:
REVIEW OF EXCLUDED PROVIDERS IN THE MEDICARE PART D PROGRAM
The key finding was that "Contrary to Federal law, CMS accepted some PDE data submitted by sponsors for prescriptions written under the Part D program by excluded providers and used these PDE data to adjust Medicare Part D payments to sponsors at the end of the plan year. Of approximately $185 billion in gross drug costs included in sponsors' PDE data for calendar years 2006 through 2008, CMS accepted PDE data with gross drug costs totaling $15,079,608 for prescriptions written by excluded providers. Furthermore, CMS accepted PDE data with gross drug costs totaling an additional $1,985,315 for prescriptions that may have been written by excluded providers."
Citing "inadequate internal controls", the OIG recommends several procedural changes at CMS to correct the problem. Click HERE to view the report.