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Audit faults scrutiny of AIDS drug payments

The Infectious Disease and Environmental Health Administration did not have adequate procedures to verify that claims paid by its drug assistance program for AIDS were legitimately filled, nor did it monitor inspectors at some of its food and milk processing plants, according to an audit released Monday.

Auditors found that the agency did not have a good enough oversight system in place for monitoring the pharmacies it gave $29 million in fiscal 2009.

“People were paid, but not authorized,” Legislative Auditor Bruce Myers said.

The agency — part of the Maryland Department of Health and Mental Hygiene — oversees The Maryland AIDS Drug Assistance Program, which helps low-income Maryland residents pay for medicines used to treat HIV/AIDS.

Before giving medicine to clients, pharmacies would submit authorization requests to the agency. After they had given out the medicine, pharmacies would come back to the agencies to be reimbursed for the cost of the medicine.

Sometimes, the cost listed on the authorization request and the cost listed on the reimbursement request didn’t match.

However, Myers was quick to point out that the audit identified a problem with the agency control features, not potential fraud.

The Office of Legislative Audits found the same situation three years ago. Last year, auditors were told that the agency unsuccessfully tried several options — including audits through the Medical Care Programs Administration and third parties — to fix its problem with the pharmacies.

However, no procedures were in place to make sure that only valid pharmacy claims were submitted and paid.

Auditors also found that the agency was “pretty much relying on the inspectors to do the work and do it right,” without much supervision at the processing plants they inspected, Myers said.

At another center, there was no evidence that the agency was conducting reviews of the work that had been done, Myers said.

In its response to the audit, the agency said it concurred with all the findings.

The agency also said it has come up with a new way to address the problems with pharmacies. The Board of Public Works recently approved the hire of a private contractor to audit pharmacies participating in the Maryland AIDS Drug Assistance Program.

Officials from the agency did not return calls for comment.

Other problems identified in the audit:

-The same users could approve both licensing and inspection information. Additionally, licenses that were issued were not properly approved.

-The agency did not conduct the required program reviews of local health departments.

-Core Public Health Services grant proposals were not reviewed in a timely manner and were not all complete.

-State money in bank accounts maintained by a private contractor was not adequately monitored to make sure the aggregate monthly balance didn’t exceed the value of the fidelity bond.

-The agency did not exercise adequate controls over collections, and did not make timely deposits.