Fort Worth pharmacy overpaid for some Medicaid client prescriptions

A recent audit conducted by the OIG found a pharmacy was overpaid $958 for prescriptions dispensed to Texas Medicaid and Children’s Health Insurance Program (CHIP) members. 

The audit, which covered the period from October 1, 2019, through August 31, 2022, found that Meadowbrook Pharmacy correctly dispensed prescriptions for 422 of the 437 encounters tested. However, in a few instances, they did not comply with certain requirements for dispensing refills, accurately submitting claims, providing instructions for use and maintaining supporting documentation.

 Specifically, the issues identified included:
•    One claim for an unauthorized refill.
•    Four claims with unauthorized medication substitutions.
•    One claim with missing confirmation of medication delivery.
•    Two claims with inaccurate days’ supply to circumvent managed care organization (MCO) limits.
•    One claim for a dispensing label with incomplete instructions for use.
•    Six claims for compounded medications without documentation of the methodology, equipment or container used.
Among additional actions, the OIG has recommended that Meadowbrook improve its dispensing processes to ensure prescriptions are filled as authorized by the prescriber, update its claim submission process and implement a system that prints complete dispensing labels and instructions.

Meadowbrook has agreed with the audit recommendations and indicated corrective actions will take place. 
During the audit period, Meadowbrook received $4,971,555 to provide prescription services to 46,847 Texas Medicaid and CHIP clients enrolled with Cook Children’s Health Plan or Wellpoint Insurance Company.