HHS-OIG is raising concerns regarding copay coupons offered by pharmaceutical manufacturers. In a September 2014 special advisory bulletin on the use of copayment coupons, HHS-OIG stressed that drug manufacturers are responsible for the proper use of the coupons and face stiff penalties for any improper use.
According to the bulletin, “Pharmaceutical manufacturers that offer copayment coupons may be subject to sanctions if they fail to take appropriate steps to ensure that such coupons do not induce the purchase of Federal health care program items or services, including, but not limited to, drugs paid for by Medicare Part D.”
In addition to the bulletin, HHS-OIG also released a report that said drug manufacturers are failing to ensure that copayment coupons aren’t used for any drugs paid for by federal healthcare programs, specifically Medicare Part D. The report said that while most drug manufacturers have edits built into their pharmacy claims transaction systems designed to stop copayment coupons from being used for drugs paid for by Medicare Part D, “claims processing edits currently in use may not stop all coupons from being processed for drugs paid for by Part D because manufacturers cannot accurately identify a beneficiary’s Part D enrollment status.”
The claims edits may not contain Medicare Part D enrollment information and can often include incorrect data, the OIG said.
Because such dereliction of duties might run afoul of the False Claims Act, potential whistleblowers are greatly incentivized to identify drug manufacturers and pharmacies that, in effect, use copayment coupons to bribe government healthcare beneficiaries.
More information for whistleblowers is located at the Nolan Auerbach & White website.