State Report: Illinois

The administration of Illinois Governor Rod Blagojevich (D) has hidden its state budget problems by rolling over an average of $1.5 billion in Medicaid claims each year since 2005.

The audit also found the Illinois Department of Healthcare and Family Services (HFS) took about 77 days to reimburse "non-expedited" claims-those submitted by physicians and pharmacists who care for low-income or aging patients but are not associated with large hospitals. If a non-expedited claim included a coding error resulting in a reimbursement delay, providers generally had to wait an additional 87 days for reimbursement. Further, the audit identified 123 error codes for rejecting services that were not on the error-code list found in HFS's provider handbook.



In March, CVS Caremark agreed to pay $36.7 million to settle allegations that it overbilled Medicaid for the drug ranitidine for more than six years, according to the Chicago Tribune.

According to federal prosecutors, CVS Caremark filled prescriptions for Medicaid beneficiaries with the capsule form of ranitidine, rather than the tablet form. Medicaid establishes maximum reimbursement rates for the tablet form but not for the capsule form, which costs more. By switching to the capsule, CVS Caremark was able to bill Medicaid as much as 400% more for the drug. The settlement ends a whistleblower lawsuit filed in 2003 by a Northbrook, Ill., pharmacist in U.S. District Court for Northern Illinois. The federal government, 23 states and Washington, D.C., later joined the suit.


MHE Sources: CMS; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The Commonwealth Fund.

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