The state Medicaid program paid more than $1.1 million in outpatient prescriptions in violation of state regulations over a two-year period ending January 2014, state auditors said Monday.
Medicaid paid for 5,154 prescriptions involving claims without the necessary approvals, according to .
During fiscal year 2014, the state Medicaid program covered 5.5 million outpatient prescriptions for 498,507 recipients. The total cost of those drugs was $453.2 million but, after federal reimbursements and rebates from drug manufacturers, the state paid $101.8 million.
From fiscal year 2010 to 2014, the number of Medicaid prescriptions covered increased by 66 percent. The average prescription cost increased by 37 percent.
The state-federal program, a 50-50 cost share during the audit period, is administered in Colorado by the state Department of Health Care Policy and Financing to provide health care to low-income families.
Auditors found that the $1.1 million in claims that were not properly authorized might have been allowable, but the department was unable to provide evidence of it.
On the positive side, a new method of paying to ensure Medicaid recipients receive lower-priced drugs, implemented in February 2013, created an average savings of about $5.7 million a year — or $14 per recipient per prescription. About 85 percent of prescription drugs paid for by Medicaid were generic.
Auditors found the state paid for 2,053 prescriptions, costing $67,200, to providers who were excluded from serving Medicaid recipients.
The department doesn’t consistently monitor high-risk providers, auditors said, and they identified 492 medical providers whose prescribing patterns for controlled substances indicated potential fraud, waste or abuse.
