Ohio Made Incorrect Medicaid Payments to Providers for Full Vials of Herceptin

Over half of the Medicaid payments that Ohio's Department of Medicaid made to providers for full vials of Herceptin were incorrect. Of the 248 line items reviewed, 135 (54 percent) were incorrect and resulted in overpayments of about $142,000 ($91,000 Federal share). The 113 remaining line items were correct.

On all of the incorrect line items, providers reported the units of service for the entire contents of one or more vial(s), each containing 440 milligrams of Herceptin, rather than reporting the units of service for the amount actually administered.

The providers attributed the incorrect payments to clerical and billing systems errors that could not prevent or detect the incorrect billing units of service. Ohio's Department of Medicaid made these incorrect payments because it did not have sufficient edits in place during our audit period to prevent or detect the overpayments.