Department of Health

Medicaid Payments for Pharmacy Services While Recipients Reside in Nursing Homes

Many pharmacy services are included in the comprehensive Medicaid reimbursement rates for nursing homes. Accordingly, Medicaid generally should not be billed separately for these services when they are provided to nursing home residents. However, we found Medicaid sometimes was billed separately for these services. During our five-year audit period, we identified about $2.1 million in potentially inappropriate payments for such pharmacy services. We recommended that the payments be investigated, all inappropriate payments recovered, and controls improved to prevent such payments in the future.

For a complete copy of Report 2007-S-88 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.