Paduda: What We Found: The Audit Results

Tuesday, April 11, 2023 | 0

Our report on the audit of the Federal Employees' Compensation Act work comp pharmacy program is now public.

Joe Paduda

The key findings? During the audit period (FY 2015-FY 2020):

• 1330 oral fentanyl scripts were dispensed and paid for without evidence of required cancer diagnosis (remember Actiq and Fentora?).
• That does not include any such scripts that were dispensed and paid for before the audit period.
• More than 25,000 scripts that should not have been filled were.
• Agencies, departments and taxpayers spent $300 million more than they should have because they didn’t use competitive pricing metrics and methods.
• The Labor Department failed to address opioids and compounds in a timely manner. In both cases, DOL was years behind the private sector and state government comp programs.
• The FECA program, the biggest single work comp payer in the nation, didn’t have a full-time medical director or clinical pharmacist.

Before you ask, we did not assess or otherwise study the potential impact of these findings on injured workers, as that was outside the scope of the project.

The audit covers fiscal years 2015-2020. The analysts and pharmacists at HealthPlan Data Solutions did the analytical heavy lifting, crunching data on millions of scripts and reimbursements. HDS handled the clinical questions as well. CompPharma provided a lot of qualitative assessment and program operational benchmarks. (Thanks to all who participate in our annual survey of drug management in workers' comp.)

Accounting firm HRK was the lead on this (it speaks Federalese and has the right credentials to navigate the federal contracting system).

What does this mean for you?

Audits can be really useful. 

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.