More than 1,000 pharmacies in Wisconsin were denied a total of $2.7 million over four years in Medicare Part D claims because of a billing error by a contractor with the state’s Medicaid program.
The state sent letters to the pharmacies this week telling them how to get the money back.
The contractor, Health Management Systems, or HMS, incorrectly billed six Medicare Part D insurance companies for nearly 37,000 claims involving more than 7,000 Medicaid recipients from October 2013 to this February, said Elizabeth Goodsitt, a spokeswoman for the state Department of Health Services.
The state’s Medicaid program had already recouped the payments from the pharmacies, Goodsitt said. That is done when Medicaid pays for prescription drugs and then learns Medicaid recipients have Medicare Part D coverage, which is supposed to be the primary payer, she said.
After the mistake by HMS, the six Medicare Part D insurers paid the state for the claims. When the pharmacies tried to get the money from the companies, their claims were denied.
The Medicaid program received duplicate payments, totaling $2.7 million. The state is giving that money back to the insurance companies and telling 1,102 pharmacies to resubmit their claims to the companies.
Danielle Laurent, spokeswoman for the Pharmacy Society of Wisconsin, said resubmitting the claims could be routine in some cases but difficult in others.
Goodsitt said HMS “has addressed the system error that caused the duplicate payments to Wisconsin Medicaid.”