Inappropriate Part D Payments for Part A SNF Beneficiaries

The OIG recently released a report entitled "Medicare Part D Payments For Beneficiaries In Part A Skilled Nursing Facility Stays In 2006."  The purpose of the review was to determine the extent to which Medicare Part D paid for drugs for beneficiaries in Part A SNF stays in 2006.  The OIG found that Part D payments were widespread among SNFs and pharmacies - indeed, nearly every SNF and half of all pharmacies had beneficiaries who had a drug paid for by Part D during their Part A SNF stay.  Significantly, Part D paid for 1.2 million drugs, amounting to $75 million, for beneficiaries in Part A SNF stays in 2006 and the majority of these payments were most likely inappropriate.

The OIG recommended that CMS:

• Provide additional guidance about when Parts A and D can pay for drugs for beneficiaries preparing for discharge;
• Educate SNFs, pharmacies, and Part D sponsors that drugs covered under Parts A or B for beneficiaries in SNF stays are not eligible for payment under Part D;
• Implement retrospective reviews to prevent inappropriate Part D payments for drugs for this population; and
• Follow up with the SNFs and pharmacies that were responsible for a large percentage of Part D payments for beneficiaries in Part A SNF stays.

To read OIG OEI-02-07-00230 (June 2009) click here.