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Pharmacies have been overpayed for five years



Published: Sat, June 11, 2005 @ 12:00 a.m.



Officials say they should be able to recover the money.

COLUMBUS (AP) -- The state's Medicaid system overpaid pharmacies by about $69 million over a five-year period, according to an independent study.

Officials with the Ohio Department of Job and Family Services attribute most of the problem to a 2003 update of its computerized system for paying pharmacy claims. They said the system has been fixed and they should be able to recover much of the money.

The state inspector general released a report in January that said the department had failed to collect millions of dollars in overpayments for incorrect or fraudulent bills from doctors and hospitals. The department responded with a plan to aggressively pursue overpayments and review its policies.

The independent study, obtained last week by the Columbus Dispatch, was done for the Ohio Commission to Reform Medicaid, a panel of experts that lawmakers told to find potential savings. It found more than 1.2 million duplicate claims paid off from 2000 to 2004.

The computer system is supposed to document when the state pays for prescription drugs that aren't given to patients, then subtract that amount from the next payment to the pharmacy. Job and Family Services officials said the system didn't execute the process correctly from November 2003 to March 2005.

Discovered in '03

Barbara Edwards, who directs Ohio's Medicaid program for the department, said a problem was discovered in December 2003 when some bills were paid several times because they got stuck in the system. Ohio then recovered about $30 million.

Pharmacies alerted the state in February to other billing problems, department spokesman Jon Allen said.

Edwards said she's working with technicians to determine why an additional $11 million in overpayments were made before 2003. Allen said the department will try to recover the money once it determines what happened but its options could be limited because of the statute of limitations.

The review also identified about 118,000 Medicaid recipients, with approximately $700 million in prescriptions, for an unusually high amount of medical activity.

Edwards disputed the totals, saying there could be legitimate medical reasons for the recipients get multiple prescriptions or see several doctors.




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