State paid for prescriptions written by dead physicians
LANSING – Michigan pharmacies filled thousands of prescriptions written by dead and ineligible health care providers during the past three years, some more than five years after the death of the prescribing physician.
The Department of Community Health paid for 1,811 prescriptions written and filled after the death of the prescribing physician between October 2009 and June 2012 through the Medicaid program, according to the Auditor General’s Office.
The state, with funding from the federal government, reimburses pharmacies for prescriptions to Medicaid beneficiaries. It’s the responsibility of the DCH to notify pharmacy benefits managers of physicians who are not eligible to write prescriptions.
The audit did not delve into what drugs were obtained with those prescriptions, only the claims made through Medicare, DCH public information officer Angela Minicuci said.
According to the report, the DCH failed to notify the Medicaid pharmacy benefits manager, Magellan Health Services Inc., headquartered in Connecticut, of 82 dead providers during the past three years. That cost the state $89,010 to reimburse ineligible claims to 324 pharmacies.
Although that’s small a fraction of the $1.7 billion DCH shelled out for all pharmaceutical Medicaid claims during the same period, Deputy Auditor General Scott Strong said the system needs improvement.
The audit concluded DCH efforts to prevent such improper payments were only “moderately successful.”
“We looked at it in terms of the magnitude of the problem compared to the size of the program,” Strong said. “There’s opportunity for improvement but it’s not totally ineffective. It’s not completely effective, it’s not completely ineffective.”
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.
According to the audit, DCH didn’t always notify pharmacies of sanctioned providers and it didn’t have adequate controls to prevent unauthorized prescriptions from being filled.
DCH said it’s trying to remedy the problem.
“As with every audit, the Department of Community Health views this audit as an opportunity to reevaluate our policies, processes and procedures and make sure that we are providing the best possible services,” Minicuci said.
“We do agree overall with the reportable conditions that were found regarding pharmaceutical payments, and we have already begun taking steps to correct the findings and our systems, as well as recover funds when appropriate and cost-effective,” she said.
DCH has not recovered any of the money paid erroneously, Minicuci said, but is “re-evaluating DCH policy, procedures and systems to expedite identification of and eliminate future claims from processing” prescriptions from dead and sanctioned providers.
Paul Thill, a pharmacy practice professor at Ferris State University, said it’s not uncommon for physicians to die, leave the state or lose their licenses without their patients’ knowledge.
Thill said that could account for some postmortem prescription-filling.
However, Thill said a prescription can be refilled only11 times, which doesn’t explain the 570 prescriptions that the audit found filled a year or more after the prescribers’ deaths.
“The only way that could happen is if someone were forging a physician’s name,” he said.
The Michigan Pharmacists Association has not taken a formal stance on the findings of the report, but its director of governmental affairs, Karen Jonas, said pharmacists occasionally face the decision of whether to fill a prescription they know is from a dead or sanctioned provider.
As health care professionals, Jonas said pharmacists must be aware of the impacts of abruptly cutting off a patient from medication.
It is illegal to fill a prescription from an ineligible provider, but Jonas, a pharmacist of 20 years, said it’s a judgment call that professionals in her field must make.
“You’re left with that difficult situation of what you do,” she said.
“You try to ascertain whether they have enough medication to get them through until they find another provider. Do they have access to another physician in their health plan? What will the effects be?” she said. “I’m sure other pharmacists have run across that problem.”