Here’s what you should know.
1. The Centers for Medicare and Medicaid Services did not clarify what they are doing to correct the problem or whether they would update the classification.
2. The Senate wrote the Justice Department asking if it would investigate Mylan. The senators wrote in a letter that “Mylan may have knowingly misclassified EpiPens, potentially in violation of the False Claims Act and other statues.”
3. Mylan is paying a 13 percent to Medicaid for every EpiPen sold. They should be paying 23.1 percent required of brand-name drug and an inflation rebate, which is legally required because the drug is above the inflation rate.
4. CMS Spokesman Aaron Albright said that the agency informed Mylan of the issue several times, and it has not been corrected.
5. In Minnesota, the misclassification will cost the state’s Medicaid program $4.3 million in overpayments.
James Matthews, a partner at Foley & Lardner in Boston, said if the Justice Department brings a False Claims Act against Mylan “they have the ability to obtain very large, potentially massive penalties.”
6. Mylan released a statement saying the drug was coded correctly.
More coding, billing and collections news:
Kevin Moore joins Wisc.-based Aurora Health Care as Medicaid expert: 3 takeaways
Alaska health department and Xerox settle over botched Medicaid payments: 7 things to know
CareSource to offer Medicare Advantage in Ohio: 3 things to know
