Jan 4, 2023 - Health

Medicare Part B oversight gaps cost millions of dollars

The Centers for Medicare and Medicaid Services office

The Centers for Medicare and Medicaid Services office in Woodlawn, Md. Photo: Jay Mallin/Bloomberg via Getty Images

Medicare and its enrollees were unable to realize millions in savings because of gaps in the Centers for Medicare and Medicaid Services' oversight of the Part B program, according to a federal watchdog report released Tuesday.

Driving the news: The federal health department's Office of the Inspector General looked at oversight of manufacturer-reported data on average sales prices (ASP). When that data is inaccurate, Medicare may make inappropriate payments, the report said.

By the numbers: OIG found Medicare administrators could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016 and 2020.

  • Nearly a quarter of drug codes were missing ASP data for one or more specific drugs within that code in at least one quarter during that span.

What they're saying: "Given the cost and importance of these life-saving drugs, it is vital that CMS conduct robust oversight to ensure that Medicare makes appropriate payments for Part B-covered drugs," OIG wrote.

  • CMS said it "believes ASP reporting is consistent with statutory requirements and results in the determination of accurate payment limits, but that it shares OIG's concerns," per the report.
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