An individual is eligible for Medicare Part D benefits if he or she is entitled to Medicare benefits under Part A or enrolled in Part B and lives in the service area of a Part D plan. Federal regulations specify that facilities in which individuals are incarcerated are not to be regarded as being within service areas for purposes of Part D coverage.
The Centers for Medicare & Medicaid Services (CMS) inappropriately accepted prescription drug event (PDE) records submitted by Part D sponsors for prescription drugs provided to incarcerated beneficiaries and used those records to make its final payment determinations. Specifically, for 49 of the 100 beneficiaries that we sampled, CMS accepted 1,298 PDE records submitted by sponsors for prescription drugs provided to incarcerated beneficiaries. The gross drug costs associated with these 1,298 accepted PDE records totaled $326,000. On the basis of OIG’s sample results, OIG estimates that CMS accepted PDE records with gross drug costs totaling an additional $11.7 million for incarcerated beneficiaries.
Newsmax: Medicare Paid Millions for Prescription Drugs to PrisonersRead the full report