Definition
Medicaid drug rebates reduce prescription-drug costs through amounts owed by manufacturers under federal and supplemental agreements. Audits examine invoicing, collection, dispute resolution, reconciliation, and the accuracy of utilization data used to calculate rebates.
Why auditors care
Missed, delayed, or incorrectly calculated rebates increase the net cost of Medicaid pharmacy benefits. Effective controls must connect claims data, manufacturer invoices, collections, and unresolved disputes so that every amount owed can be identified and recovered.
Evidence coverage
- Reports
- 1
- States represented
- 1
- Publishing agencies
- 1
- Publication period
- 2019
State coverage reflects each report’s recorded jurisdiction.
Supporting findings
1 finding
The Commission established a billing process for MCOs to reimburse audit-related services and a process to identify and transfer experience rebates, but had unresolved disputes over some rebates.
An Audit Report on Medicaid Managed Care Contract Processes at the Health and Human Services CommissionState Auditor’s OfficeJan 2019
Recommendations
1 recommendation
The Commission should develop and implement a process to resolve disputes over experience rebates claimed by MCOs.
An Audit Report on Medicaid Managed Care Contract Processes at the Health and Human Services CommissionState Auditor’s OfficeJan 2019