A report released Friday by the Office of the Inspector General found that, under the Part D program, Medicare paid for HIV drugs for 150 dead recipients.
An analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012 determined that CMS’s current practices allowed most of these payments to occur. Although CMS has processes in place that reject PDE records for drugs with dates of service more than 32 days after death, in some cases, claims that fell outside this window were paid. Most of these drugs were dispensed by retail pharmacies.
According to OIG, “Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive.” The report points out, for example, that one common antiretroviral drug costs approximately $1,700 per month. HIV drugs accounted for one-quarter of one percent of all Part D drugs in 2012.