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1 Drug, $1.3M Medicare Overpayment in FL

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

The company that serves as Medicare's paymaster in Florida overpaid 78 percent of the claims for one breast-cancer drug over three years, according to an audit released Friday by the Department of Health and Human Services.

First Coast Service Options Inc. of Jacksonville's overpayments for the drug Herceptin amounted to $1.3 million, the audit report from the HHS Office of Inspector General says.

Of the 1,330 payments for Herceptin administration, 1,043 were incorrect, the audit found. Only one-tenth of the clinics and hospitals that received the overpayments had refunded them, the report said.

HHS recommended that First Coast recover the $1.3 million in overpayments, correct whatever glitch in its reviewing system failed to catch them, and "educate" doctor groups and hospitals on how to bill correctly.

First Coast did not contest the findings. In a letter dated Nov. 16, First Coast CEO & President Sandy Coston promised to make the corrections and prevent future problems.

The report says audits were performed nationally on Herceptin payments after a pilot audit indicated the overpayments were a potential problem. The drug, also known as trastuzumab, is sold in a multiuse vial that contains more than one dose and is good for four weeks.

Medicare pays just for the amount actually provided to patients, not for any that is discarded. The audit  of payments for full multiuse vials found that in  many cases, some of the drug had been discarded.

Herceptin, a monoclonal antibody, is administered to breast-cancer patients in whom the disease has spread to other organs, according to the report.

First Coast Service Options Inc. is the Medicare payment contractor for Florida, Puerto Rico and the U.S. Virgin Islands, the report said.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.