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New OIG report: Medicare paid for HIV drugs for deceased beneficiaries

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

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.  prescription-drugs

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.

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