The federal government has been spending hundreds of thousands of dollars on HIV drugs for Medicare patients who are already deceased, according to a federal watchdog.
The inspector general for the Department of Health and Human Services released a report Friday detailing the repercussions of a Centers for Medicare and Medicare Services policy to pay for HIV drugs up to 32 days after a patient’s death.
In 2012, the last year for which HHS has available data, Medicare paid $292,381 on HIV drugs for people who had already died, purchasing 348 different drugs for 158 dead people. And the problem doesn’t appear to be a delayed bill — for every one of the drugs, the date of service on drug records was after the patient’s date of death.
In a limited number of cases, Medicare even paid for drugs more than 32 days after the patient’s death, which should not be allowed under CMS’ current policy. Medicare paid $2,450 for three drugs over 33 days after the patient died.
CMS protested that the policy was meant to make things easier for long-term-care pharmacies, which sometimes bill Medicare Part D for drugs once a month and falsely put the billing date, not the date that the drug was sold, into their records. But in reality, just 31 of the 348 drugs that were sold within the 32 day window were sold by long-term-care pharmacies; the bulk of the payments for deceased patients were from pharmacies that don’t have an excuse for improper billing dates.
Inaccurate records can make it more difficult for watchdogs to uncover fraud, waste and abuse, according to the IG report. Unsurprisingly, the inspector general asked that CMS change its policy, and the agency agreed.
CMS has a long history of fraud and other improper payments. The General Accountability Office estimated that Medicare made over $44 billion in improper payments in 2012 alone.
HIV drugs in particular, which can be extremely expensive, make up a significant portion of Medicare Part D’s questionable spending. The HHS inspector general previously reported that in 2012, Medicare paid $32 million for HIV drugs under suspicious circumstances — including when patients didn’t have HIV at all.