OIG study, Columbia settlement expose losses linked to HIV, AIDS

Medicare Part D overpaid for HIV drugs claimed on behalf of 158 deceased beneficiaries in 2012, an Office of Inspector General study found. Most of these drugs were dispensed by retail pharmacies.

Part D sponsors submit prescription drug event records to the Centers for Medicare & Medicaid Services for each drug dispensed to enrolled beneficiaries. The overpayment for HIV drugs identified in the study occurred due to CMS accepting drug event records for medicines dispensed within 32 days of a beneficiary's death. That timeframe should be eliminated or cut, the OIG concluded.

Because CMS processes prescription drug event records for all Part D covered drugs the same way, the study's results have implications beyond HIV medicines. "Considering the enormous number of Part D drugs, a change in practice could result in significant costs savings for the program and for taxpayers," the OIG concluded.

Drugs that treat human immunodeficiency virus are prone to healthcare fraud, waste and abuse due to their high cost. For example, three HIV drugs claimed on two dates after one beneficiary's death resulted in a $7,160 overpayment, the report noted.

In another HIV and AIDS-related program integrity development, the government settled a lawsuit against Columbia University and an affiliate alleging that Columbia submitted false claims linked to federal grants obtained to fund AIDS and HIV-related work, the U.S. Department of Justice announced.

Columbia didn't verify whether salary and wage charges the International Center for AIDS Care and Treatment Programs applied to federal grants were based on an employee's actual work for that grant. As a result, ICAP incorrectly charged federal grants for work not allowable to them, the announcement noted. Columbia agreed to pay $9,020,073 to resolve the issue.

"Columbia University and ICAP applied to the federal government and received many millions of dollars to fund AIDS and HIV projects around the world," said Manhattan U.S. Attorney Preet Bharara in the announcement. "We admire and applaud Columbia's work in combating AIDS and HIV. But grantees cannot disregard the terms under which grant money is provided."

For more:
- read the OIG study abstract and report (.pdf)
- here's the DOJ announcement