Medicaid Rebates For Physician-Administered Drugs

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Office of Inspector General
http://oig.hhs.gov

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, is to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as the health and welfare of beneficiaries served by those programs. This statutory mission is carried out through a nationwide network of audits, investigations, and inspections conducted by the following operating components:

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The OIG’s Office of Evaluation and Inspections (OEI) conducts short-term management and program evaluations (called inspections) that focus on issues of concern to the department, the Congress, and the public. The findings and recommendations contained in the inspections reports generate rapid, accurate, and up-to-date information on the efficiency, vulnerability, and effectiveness of departmental programs.

Office of Investigations
The OIG’s Office of Investigations (OI) conducts criminal, civil, and administrative investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of unjust enrichment by providers. The investigative efforts of OI lead to criminal convictions, administrative sanctions, or civil monetary penalties. The OI also oversees State Medicaid fraud control units, which investigate and prosecute fraud and patient abuse in the Medicaid program.

Office of Counsel to the Inspector General
The Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG, rendering advice and opinions on HHS programs and operations and providing all legal support in OIG’s internal operations. The OCIG imposes program exclusions and civil monetary penalties on health care providers and litigates those actions within the department. The OCIG also represents OIG in the global settlement of cases arising under the Civil False Claims Act, develops and monitors corporate integrity agreements, develops model compliance plans, renders advisory opinions on OIG sanctions to the health care community, and issues fraud alerts and other industry guidance.

TABLE OF CONTENTS

ABSTRACT

EXECUTIVE SUMMARY

INTRODUCTION

FINDINGS
– States that collected, or did not collect, rebates on physician-administered drugs in 2001
– Medicaid could have saved millions in 2001
– States that began collecting rebates after 2001
– Implementation costs can be recovered quickly

RECOMMENDATION

APPENDIX A
– Table 1. Summary of 2001 State Medicaid Data for Physician-Administered Drugs
– Table 2. Selected Physician-Administered Multiple-Source Drugs (n=40)
– Table 3. Potential Medicaid Savings on Rebates for Physician-Administered Drugs in 2001

APPENDIX B
– Agency Comments

ACKNOWLEDGMENTS