Managed Care Pharmacy Encounters Paid to Omnicare Pharmacy
Learn how the AI-generated research projects were createdOverall Conclusion
Omnicare Pharmacy (Omnicare) filled and dispensed prescriptions for Texas Medicaid members; however, Omnicare did not consistently comply with certain requirements for dispensing medication, confirming medication delivery, providing instructions for use, and accurately submitting claims. As a result, Omnicare was overpaid and should repay $2,275.44 to the state of Texas.
Source Document
Audit Scope
The audit scope covered the period from March 1, 2020, through August 31, 2022.
Key Findings Summary
Omnicare did not consistently comply with dispensing requirements, resulting in an overall overpayment of $2,275.44.
One claim with a prescription order that was not signed by the prescriber, resulting in an overpayment of $287.26.
Three claims for medications dispensed more than one year after the prescription issuance date, resulting in an overpayment of $539.65.
View the Findings tab to see all 6 findings
AI-Assisted
AI Scope Summary
This audit evaluated Omnicare\'s dispensing accuracy and claims submission controls for Texas Medicaid encounters during March 1, 2020, through August 31, 2022, and found specific control gaps leading to overpayments totaling $2,275.44; the findings underscore the importance of ensuring signed prescriptions, confirmed delivery, correct issuance dates, and accurate labeling in ongoing Medicaid audits.
AI-Generated Insight
The audit found that while dispensing accuracy was generally maintained, gaps in documentation, labeling accuracy, and timing of claims submission led to material overpayments. Strengthening internal controls around prescription validation, delivery verification, and data integrity across managed care organizations and PBMs is essential to reduce financial risk in Texas Medicaid encounters.
Audit Objectives
Determine whether Omnicare properly dispensed prescriptions associated with selected encounters for Texas Medicaid members enrolled with Superior HealthPlan and UnitedHealthcare.
Determine whether Omnicare complied with applicable contractual, state, and federal requirements.
Audit Findings (6)
Omnicare did not consistently comply with dispensing requirements, resulting in an overall overpayment of $2,275.44.
One claim with a prescription order that was not signed by the prescriber, resulting in an overpayment of $287.26.
Three claims for medications dispensed more than one year after the prescription issuance date, resulting in an overpayment of $539.65.
Three claims missing confirmation of medication delivery, resulting in an overpayment of $1,448.53.
One claim with a dispensing label containing inaccurate instructions for use.
Forty-one claims with incorrect prescription issuance dates.
Recommendations (3)
Improve dispensing processes to verify each medication dispensed has (a) a signed, current prescription order and (b) documentation of medication delivery for submitted claims.
Implement a process to verify dispensing labels contain the correct instructions for use.
Update claim submission process to verify it submits the correct prescription issuance date for each prescription.