Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
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San Francisco Examiner - November 7, 2007
Karl B. Hille, khille@baltimoreexaminer.com
The administration did not verify that claims were "supported by valid physician prescriptions" or that they "had not also been paid by third party insurers," including the state's own Maryland Health Insurance Program (MHIP), according to the report released by the Office of Legislative Audits. "As a result, a pharmacy could request authorizations to dispense medications that were not prescribed ... or bill the Administration for claims that were also paid by third party insurers."
Out of a $54 million annual budget, the AIDS Administration spends about $1.6 million in insurance premiums through MHIP, according to the audit.
In 2006, the administration covered $1.4 million in pharmacy claims directly, in addition to $1.2 million in claims through MHIP.
In response, Health Secretary John Colmers wrote that the administration was seeking outside auditors to ensure Maryland does not pay claims that should be covered by private insurance.
Additional audits will ensure drugs are dispensed with a valid prescription and that the state does not pay twice.
The administration will automatically reject drug payment claims when they don't have documentation showing why any third-party insurance refused coverage.
The Maryland AIDS Drug Assistance Program (MADAP), through which the administration ultimately pays its claims, is "absolutely critical" to the fight against AIDS, said Baltimore City Health Commissioner Dr. Joshua Sharfstein. "Whatever system they implement, it has to be done well."
State law says MADAP is the "payer of last resort," said Baltimore's HIV Clinician Dr. Laura Herrera. "Generally once [people are] enrolled, there's no problem getting their prescriptions filled."
Any gaps in prescription coverage could be critical, Sharfstein said, because HIV quickly adapts to failures to keep up treatment.
AIDS Administration audit findings:
* No controls prevented paying for drugs for insured individuals
* No verification of whether prescriptions were valid or the state was paying twice
* Access to the claims and payment database was not adequately restricted
* Bank accounts maintained by a private contractor were not properly insured
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