Potentially inappropriate nursing home payments spur increased Medicare Part A, Part D oversight

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Tens of millions of dollars were likely inappropriately paid to skilled nursing facilities through the Medicare Part D prescription drug program in 2006, according to a recently released report from the Department of Health and Human Services Office of the Inspector General.

According to the OIG report, Part D spent roughly $41 million that year to pay for drugs for nursing home residents who should have been covered under the Medicare Part A benefit. While admitting that a small number of facilities constituted the vast majority of inappropriate payments-30 long-term care pharmacies were responsible for 18% of the payments-investigators say that nearly every SNF and half of all pharmacies have at least one Part A patient inappropriately receiving Part D subsidized prescriptions.

In response to the oversight, the OIG made a series of recommendations to the Centers for Medicare & Medicaid Services, which include more oversight and guidance for skilled nursing facilities. Specifically, OIG told CMS to implement retrospective reviews to prevent future inappropriate payments, and to further educate facilities, pharmacies and drug plans about which Medicare plan is responsible for which medication repayment.  
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