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Audit: Utah Medicaid prescription drug system susceptible to fraud

By Wendy Leonard | Posted - Aug. 17, 2016 at 8:02 p.m.



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SALT LAKE CITY — Utah has one of the highest per capita opioid death rates, and officials have taken note.

State lawmakers have urged the Utah departments of health, human services and public safety, as well as other agencies, to identify ways they can help cut down the number of drug overdose deaths that involve Medicaid prescriptions and patients using the state and federally funded program.

An audit released Wednesday did just that.

"Prescription drug abuse is a societal concern," said Utah Auditor John Dougall, adding that the recent but in-depth and complex audit uncovered some significant weaknesses in how Medicaid handles prescription drugs for patients.

The audit shows Medicaid dollars have been used to cover a number of prescriptions written by deceased prescribers, dispensed in the name of deceased recipients and not all providers ordering prescriptions paid for by Medicaid are authorized to be prescribing drugs for Medicaid patients, among other things.

Dougall said only a small number of prescriptions came up suspicious, but each of those poses a potential risk of abuse.

"The last thing we want is to have a government-run program dispensing drugs people are abusing," he said, adding that identifying such problems gives Medicaid officials a heads up to fix them.

The Medicaid prescription drug program was letting slide a very small number of prescriptions written by doctors who had died — one as long as eight months prior — as its system didn't capture data from the Office of Vital Records and Statistics as it needed to, according to the audit.

The deep dive into pharmacy records during the first six months of this year also revealed that Medicaid paid for other prescriptions dispensed in the name of recipients who had died, which was also something Medicaid officials were unaware was happening because of system inefficiencies with a contracted vendor, according a letter of response from the Utah Department of Health, which oversees the Medicaid program in Utah.

State health department officials noted they are grateful for the added perspective and are already working to improve the program. Response from the department indicated that officials were able to reverse some of the transactions and recoup some of the money spent on potentially fraudulent or erroneous prescriptions.

"We believe that the results of our combined efforts will make Medicaid a better, more efficient program," Nate Checketts, health department deputy director and division director of Medicaid and Health Financing, wrote in response to the audit. He said the recommendations "will be used to strengthen the policies, procedures and internal controls of the program."

Dougall said the department taking a "proactive sense is critical" in correcting the problems, and might aid in lowering the number of prescription drug overdose deaths in Utah.

The 83-page audit can be found at auditor.utah.gov.

"We want to help ensure that program dollars are used in the best way possible," Dougall said. "Most folks recognize there's a reason for certain welfare programs, and we conduct these audits to make sure money spent on these programs is not being wasted."

Wendy Leonard

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