The HHS Office of Inspector General found during an audit to determine whether Medicare Part D sponsors correctly reported pharmacy fees that Geisinger didn't report its point-of-sale fees for three years.
The audit found that MedImpact, Danville, Pa.-based Geisinger's pharmacy benefit manager, received point-of-sale fees totaling $149,199 in 2013, $167,798 in 2014 and $152,853 in 2015. The health system did not report the fees in its summary direct and indirect remuneration reports.
Because Geisinger understated its DIR amounts, CMS used allowable costs that were overstated by $469,850 to make its final payment determination for the three years.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 requires that CMS calculate the difference between the prospective payments received by a sponsor and the actual allowable costs incurred.
Geisinger said the fees weren't reported because of an unintentional oversight.
The OIG recommended Geisinger refile its DIR reports for 2013, 2014 and 2015. Geisinger agreed with the recommendation.
Read the full report here.