Ohio Medicaid overpaid $90,000 for cancer drug

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Ohio Medicaid overpaid $90,000 for cancer drug

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Billing errors led to Ohio overpaying for a cancer drug.

A Medicaid billing error led to Ohio overpaying more than $90,000 for a cancer drug, according to a new report from the Health and Human Services Office of Inspector General.

The federal agency began looking into how states were billing for Herceptin, a treatment for breast cancer, after finding that Medicare was over-billed for the drug to the tune of $24.2 million.

The problem is that Herceptin comes in a vial with 440 milligrams of the drug. Each patient doesn’t usually require a full vial, so the vials can be used multiple times for about a month.

But Medicare and Medicaid were being billed for full vials when patients were only being given a portion.

An investigation into Medicare’s billing found 77 percent of the time, the drug was over-billed.

In looking at individual states, the Inspector General found in Ohio half the billings for full vials were incorrect between 2012 and 2014, totalling $90,580 in over-billing to the federal government.

Louisiana, New York, Indiana, Arkansas, Texas and Illinois Medicaid programs have had similar findings.

The OIG has asked the state to recover the overpayments from providers and to update its billing system so that multi-use drugs like Herceptin are billed properly.

Ohio’s Department of Medicaid responded to the report saying more than $71,000 has already been recovered and the state is educating providers so the drug is billed properly.

The state argues that only 2.5 percent of all Herceptin claims during the investigation period were incorrect.

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