Department of Health

Medicaid Payments for Pharmacy Services While Recipients Resided in Nursing Homes (Follow-Up Report)

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, in audit report 2007-S-88, 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. When we followed up on these matters with Department officials, we found that they had made only limited progress in implementing our audit recommendations.

For a complete copy of Report 2009-F-11 click here.
For a copy of the 30-day response click here.