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Program Integrity

FY13 Audit Results

Updated 06/26/15. The results chart includes audits where the findings have been finalized. Remaining audits are still under review. Information on Corrective Action Plans and Sanctions will be updated once approved by HRSA. HRSA recommends manufacturers do not contact audited entities regarding sanctions until a corrective action plan has been approved by HRSA and posted on this website.

Results posted for (92) audits.

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z 

Alder Health Services, Inc. (PA)

340 ID: RWII17101

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Allegan General Hospital (MI)

340 ID: CAH231328-00

OPA Findings:

  1. Incorrect 340B database record - Registered contract pharmacies without written contract in place;
  2. Diversion – 340B drug dispensed to inpatient; 340B drug dispensed at contract pharmacy, not supported by a medical record.

Sanctions: Repayment to manufactures.

Corrective Action: Public letter to manufacturers (PDF - 33 KB).

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Aspirus Medford Hospital and Clinics, Inc. (formerly Memorial Health Center) (WI)

340 ID: CAH521324-00

OPA Findings:

  1. Incorrect 340B database record - Offsite outpatient facilities were not listed on the 340B database;
  2. Diversion – 340B drugs dispensed to inpatients; 340B drugs dispensed for prescriptions written by ineligible providers.

Sanctions: Repayment to manufactures.

Corrective Action: Pending.

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Athens Regional Medical Center (GA)

340 ID: DSH110074

OPA Findings:

  1. Diversion – 340B drugs dispensed for prescriptions written at ineligible sites by ineligible providers; 340B drugs were not properly accumulated;
  2. Duplicate Discounts – Medicaid billing numbers were incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufactures.

Corrective Action: Public letter to manufacturers (PDF - 123 KB).

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Aurora Health Care Metro, Inc. (WI)

340 ID: DSH520138

OPA Findings:

  1. Incorrect 340B database record – Offsite outpatient facilities were not listed on the 340B database;
  2. Diversion – 340B drugs dispensed at covered entity and at contract pharmacies for prescriptions written by ineligible providers.

Sanctions: Repayment to manufactures.

Corrective Action: Public letter to manufacturers (PDF - 118 KB). Audit closure date: May 15, 2015.

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Avera McKennan Hospital and University Health Center (SD)

340 ID: DSH430016

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Baptist Hospitals of Southeast Texas DBA Memorial Hermann Baptist Orange Hospital (TX)

340 ID: DSH450005

OPA Findings: Diversion – 340B drugs dispensed at contract pharmacies for prescriptions originating at ineligible sites

Sanctions: Repayment to manufactures.

Corrective Action: Public letter to manufacturers (PDF - 97 KB).

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Baptist Medical Center (FL)

340 ID: DSH100088

OPA Findings: Incorrect 340B database record - Registered contract pharmacies without written contract in place.

Sanctions: None.

Corrective Action:Contracts executed; 340B Program policies and procedures revised to address contract pharmacy registration. Audit closure date: June 16, 2015.

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Baptist Memorial Hospital – Desoto (MS)

340 ID: DSH250141

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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BayState Medical Center (MA)

340 ID: DSH220077

OPA Findings: Diversion – 340B drug dispensed for prescription written by ineligible provider.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 51 KB). Audit closure date: January 22, 2015.

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Beacon Christian Community Health Center (NY)

340 ID: CHC12866-00

OPA Findings: Incorrect 340B database record - Registered contract pharmacies without written contract in place;

Sanctions: None.

Corrective Action: Contracts executed; 340B Program policies and procedures revised to address contract pharmacy registration. Audit closure date: September 23, 2014.

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Boone County Hospital (IA)

340 ID: CAH161372-00

OPA Findings:

  1. Incorrect 340B database record - Offsite outpatient facilities were not listed on the 340B database;
  2. Diversion – 340B drug dispensed to inpatient.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 46 KB). Audit closure date: December 31, 2014.

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Borrego Community Health Foundation (CA)

340 ID: CH099010

OPA Findings:

  1. Diversion – 340B drugs dispensed at contract pharmacy, not supported by a medical record; 340B drugs dispensed for prescriptions written by ineligible providers;;
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 68 KB).

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Calhoun-Liberty Hospital (FL)

340 ID: CAH101304-00

OPA Findings:

  1. Entity failed to maintain auditable medical records prior to December 1, 2014;
  2. Diversion – Entity did not have a mechanism in place to prevent diversion.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Capital Health System - Hopewell (NJ)

340 ID: DSH310044

OPA Findings:

  1. Entity does not meet 340B eligibility requirements (DSH %);
  2. Diversion – 340B drugs dispensed for prescriptions originating at ineligible sites, not supported by responsibility of care;
  3. Diversion – 340B drugs were not properly accumulated.

Sanctions: Covered entity removed from 340B Program; Repayment to manufacturers.

Corrective Action: Pending.

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Castle Medical Center (HI)

340 ID: DSH120006

OPA Findings:

  1. Incorrect 340B database record – Offsite outpatient facility was not listed on the 340B database; Incorrect entry for shipping address;
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information contained in the Medicaid Exclusion File.

Sanctions:

Corrective Action: Public letter to manufacturers (PDF - 270 KB). Audit closure date: March 31, 2015.

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Chadron Community Hospital – Western Community Health Resources (NE)

340 ID: FP693011

OPA Findings:

  1. Incorrect 340B database record – incorrect address listed for offsite outpatient facility.
  2. Diversion – 340B drugs dispensed for prescription written by ineligible provider at ineligible site.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 208 KB).

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Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center (PA)

340 ID: PED393302-00

OPA Findings:

  1. Incorrect 340B database record - Offsite outpatient facilities were not listed on the 340B database; Registered contract pharmacies without written contract in place;
  2. Duplicate Discounts – NPI and Medicaid billing numbers were incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 36 KB).

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Christ Community Health Services, Inc. (TN)

340 ID: CH0417140

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Christus Health Shreveport- Bossier (formerly Christus Schumpert Health System) (LA)

340 ID: DSH190041

OPA Findings:

  1. Entity did not provide contract pharmacy oversight;
  2. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions written at ineligible sites.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 80 KB).

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Citizen’s Baptist Medical Center (AL)

340 ID: DSH010101

OPA Findings: Incorrect 340B database record – Incorrect Authorizing Official;

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: July 25, 2014.

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Citizens Memorial Hospital District (MO)

340 ID: DSH260195

OPA Findings:

  1. Incorrect 340B database record – Pharmacy incorrectly registered as child site;
  2. Diversion – 340B drugs dispensed to ineligible individual, not supported by a medical record.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 17 KB). Audit closure date: May 7, 2015.

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Clinch River Health Services, Incorporated (VA)

340 ID: CH031230

OPA Findings:

  1. Incorrect 340B database record – Contract pharmacy with written contract in place was not listed on the 340B database;
  2. Entity did not provide contract pharmacy oversight
  3. Diversion – 340B drugs dispensed at contract pharmacy for prescriptions written by ineligible providers, and to non-patients.
  4. Duplicate Discounts – Entity was billing Medicaid contrary to information contained in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers (PDF - 23 KB).

Corrective Action: Public letter to manufacturers.

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Community Medical Center, Inc. (MT)

340 ID: DSH270023

OPA Findings:

  1. Incorrect 340B database record – incorrect names and addresses for offsite outpatient facilities listed;
  2. iversion – 340B drug dispensed for a prescription written at an ineligible site, not supported by responsibility of care.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Community Regional Medical Center (CA)

340 ID: DSH050060

OPA Findings:

  1. Incorrect 340B database record – Inpatient facility incorrectly registered as child site;
  2. Diversion – 340B drugs dispensed to ineligible individuals.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 70 KB).

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Contra Costa Regional Medical Center (CA)

340 ID: DSH050276

OPA Findings: Incorrect 340B database record – Incorrect name listed for outpatient facility.

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: September 11, 2014.

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Cook Children’s Medical Center (TX)

340 ID: PED453300-00

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Crusader’s Central Clinic Association (IL)

340 ID: CH052760

OPA Findings:

  1. Incorrect 340B database record – An offsite outpatient facility was not listed on the 340B database.
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 19 KB). Audit closure date: March 9, 2015.

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Cuyuna Regional Medical Center (MN)

340 ID: CAH241353-00

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Dallas County Hospital District Parkland Health and Hospital System (TX)

340 ID: DSH450015

OPA Findings: Diversion – 340B drugs dispensed at contract pharmacies for prescriptions written by ineligible providers at ineligible sites.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Dell Children’s Medical Center (TX)

340 ID: PED453310-00

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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East Central District Health Department (NE)

340 ID: FP686011

OPA Findings: Duplicate Discounts - Medicaid billing number was incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF 27 KB).

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East Orange General Hospital (NJ)

340 ID: DSH310083

OPA Findings:

  1. Covered outpatient drugs obtained through a Group Purchasing Organization prior to August 30, 2013;
  2. Incorrect 340B database record - Registered contract pharmacy without written contract in place;
  3. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions originating from ineligible sites; 340B drugs were not properly accumulated;
  4. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Eau Claire Cooperative Health Center, Inc. (SC)

340 ID: CH043270

OPA Findings:

  1. Incorrect 340B database record - Offsite outpatient facilities were not listed on the 340B database; Incorrect names and addresses listed for outpatient facilities;
  2. Diversion – 340B drugs dispensed for prescriptions originating from ineligible sites, written by ineligible providers, not supported by medical records;
  3. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 81 KB).

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Ephraim McDowell Regional Medical Center, Inc. (KY)

340 ID: DSH180048

OPA Findings: Diversion – 340B drugs dispensed for prescriptions originating from ineligible sites, written by ineligible providers; 340B drugs were not properly accumulated

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 37 KB).

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Family Health Centers of San Diego (CA)

340 ID: CH093120 FP92102

OPA Findings: Diversion – 340B drugs dispensed, not supported by medical records.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers. (PDF - 40 KB).

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Family Health Services of Cranston(RI)

340 ID: FP029107

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Floyd Valley Hospital (IA)

340 ID: CAH161368-00

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Franciscan St. Anthony Health Michigan City (IN)

340 ID: RRC150015-00

OPA Findings: Incorrect 340B database record – An outpatient facility was not listed on the 340B database; Registered contract pharmacies without written contract in place.

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Contracts executed.Audit closure date: December 22, 2014.

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Georgia Dept of Public Health (GA)

340 ID: RWIID303031

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Grady General Hospital (GA)

340 ID: DSH110121

OPA Findings:

  1. Diversion – 340B drugs dispensed for prescription written by ineligible provider; 340B drugs dispensed to non-patients.
  2. Duplicate Discounts – Medicaid Provider Number was incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers. Audit closure date: May 11, 2015.

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Hamblen County Health Department (TN)

340 ID: STD378146

OPA Findings:

  1. Incorrect 340B database record – Incorrect entries for authorizing official and shipping address;
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 38 KB).

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Henry Ford Hospital (MI)

340 ID: DSH230053

OPA Findings: Diversion – Entity did not have adequate controls in place for proper accumulation and prevention of diversion.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Holmes County General Health District (OH)

340 ID: FP44654

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Holy Cross Hospital (IL)

340 ID: DSH140133

OPA Findings:

  1. Incorrect 340B database record – Incorrect entries for Authorizing Official and Primary Contact;
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 88 KB).

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Iraan General Hospital District (TX)

340 ID: CAH451307-00

OPA Findings:

  1. Non-reimbursable facilities incorrectly registered as child site;
  2. Incorrect 340B database record – incorrect entries for Primary Contact and Authorizing Official;
  3. Diversion – 340B drugs dispensed for prescriptions written at ineligible sites.

Sanctions: Ineligible sites removed from 340B Program; Repayment to manufacturers.

Corrective Action: Pending.

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Lawrence General Hospital (MA)

340 ID: DSH220010

OPA Findings: Diversion – 340B drugs dispensed to inpatients; 340B drug dispensed not supported by a medical record.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 129 KB). Audit closure date: November 3, 2014.

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Legacy Emanuel Medical Center (OR)

340 ID: DSH380007

OPA Findings:

  1. Diversion – 340B drugs dispensed for prescriptions originating from ineligible sites;
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Los Angeles County Department of Health Services – USC Medical Center (CA)

340 ID: DSH050373

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Loyola University Medical Center (IL)

340 ID: DSH140276

OPA Findings: Incorrect 340B database record – Contract pharmacy with a written contract in place was not listed on the 340B database.

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: November 18, 2014.

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Madera Community Hospital (CA)

340 ID: DSH050568

OPA Findings: Incorrect 340B database record – Outpatient facilities of the hospital were not listed on the 340B database

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: July 25, 2014.

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Mary Rutan Hospital (OH)

340 ID: SCH360197-00

OPA Findings:

  1. Incorrect 340B database record – Non-reimbursable facilities incorrectly registered as child site;
  2. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions originating from ineligible sites, written by ineligible providers at ineligible sites; 340B drugs dispensed at non-reimbursable facilities, for prescriptions originating from non-reimbursable sites.

Sanctions: Ineligible sites removed from 340B Program; Repayment to manufacturers.

Corrective Action: Pending.

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Matagorda Regional Medical Center (TX)

340 ID: DSH220010

OPA Findings: Diversion – 340B drug dispensed, not supported by a medical record.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Medical Center Hospital (TX)

340 ID: DSH450132

OPA Findings:

  1. Entity did not provide contract pharmacy oversight;
  2. Diversion – 340B drugs dispensed at contract pharmacy for prescriptions originating from ineligible site.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 72 KB).

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Memorial Health System (CO)

340 ID: DSH060022

OPA Findings:

  1. Incorrect 340B database record – Closed offsite outpatient facility listed on database;
  2. Diversion – 340B drugs dispensed for prescriptions written by ineligible providers and/or at ineligible sites; 340B drugs dispensed to employees for prescriptions written by ineligible providers and/or at ineligible sites.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Methodist Healthcare – Memphis Hospitals (TN)

340 ID: DSH440049

OPA Findings:

  1. Incorrect 340B database record – Outpatient facilities of the hospital were not listed on the 340B database; Contract pharmacy with written contract in place was not listed on the 340B database;
  2. Diversion – 340B drugs dispensed for prescriptions originating from ineligible sites, written by ineligible providers;
  3. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 171 KB).

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Mt. Sinai School of Medicine (NY)

340 ID: HM7439

OPA Findings: Duplicate Discounts – Medicaid billing number was missing on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Muhlenberg Community Hospital, Inc. (KY)

340 ID: DSH180004

OPA Findings: Diversion – 340B drug dispensed for prescription written at ineligible site; 340B drugs dispensed to inpatients; 340B drugs were not properly accumulated.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 98 KB).

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Nemours / Alfred I. Dupont Hospital for Children (DE)

340 ID: PED083300-00

OPA Findings:

  1. Incorrect 340B database record – Registered contract pharmacies without written contract in place;
  2. Diversion – 340B drugs dispensed for prescriptions originating from ineligible sites; 340B drugs dispensed at contract pharmacy for prescription written by ineligible provider.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 46 KB).

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Niagara Falls Memorial Medical Center (NY)

340 ID: DSH330065

OPA Findings:

  1. Incorrect 340B database record – Contract pharmacies registered but entity has terminated its contract;
  2. Diversion - 340B drugs dispensed to inpatients; 340B drugs dispensed at contract pharmacies for prescriptions originating from ineligible sites; 340B drugs were not properly accumulated;
  3. Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Northeast Alabama Regional Medical Center (AL)

340 ID: DSH010078

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Oakland Mercy Hospital (NE)

340 ID: CAH281321-00

OPA Findings: Diversion – 340B drugs dispensed to inpatients.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 67 KB).

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Ochsner Medical Center – Baton Rouge, LLC (LA)

340 ID: DSH190202

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Orange County Health Department (VA)

340 ID: FP229600

OPA Findings: Incorrect 340B database record – Incorrect entry for grant number.

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: September 23, 2014.

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Oroville Hospital (CA)

340 ID: DSH050030

OPA Findings: Incorrect 340B database record – Offsite outpatient facilities were not listed on the 340B database.

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: December 22, 2014.

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Our Lady of the Lake Hospital, Inc. (LA)

340 ID: DSH190064

OPA Findings:

  1. Incorrect 340B database record - Pharmacy incorrectly registered as child site; Offsite outpatient facilities were not listed on the 340B database;
  2. Diversion – 340B drugs dispensed to inpatients.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 108 KB).

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Outer Cape Health Services, Inc. (MA)

340 ID: CH011190

OPA Findings:

  1. Diversion -340B drug dispensed for prescription written by an ineligible provider at an ineligible site;
  2. Diversion - 340B drugs dispensed to ineligible individuals due to reverse replenishment;
  3. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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PeaceHealth Southwest Medical Center (WA)

340 ID: DSH500050

OPA Findings:

  1. Incorrect 340B database record – Pharmacies incorrectly registered as child sites.
  2. Diversion – 340B drug dispensed to inpatient.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 6 KB).

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Pineville Community Hospital Assoc., Inc. (KY)

340 ID: DSH180021

OPA Findings:

  1. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions originating from ineligible sites;
  2. Duplicate Discounts - NPI number was incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 21 KB).

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Planned Parenthood Hudson Peconic, Inc. (NY)

340 ID: FP105322

OPA Findings:

  1. Incorrect 340B database record - Closed outpatient facility remained registered on the 340B database;
  2. Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 39 KB).

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Pleasant Valley Hospital (MA)

340 ID: DSH510012

OPA Findings: Incorrect 340B database record – Offsite outpatient facilities were not listed on the 340B database

Sanctions: None.

Corrective Action: Database entries corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: September 25, 2014.

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Reeves County Hospital District (TX)

340 ID: CAH451377-00

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Regional Medical Center at Memphis (TN)

340 ID: DSH440152

OPA Findings:

  1. Incorrect 340B database record –Registered contract pharmacy without written contract in place;
  2. Diversion – 340B drugs dispensed for prescriptions originating from ineligible sites;
  3. Duplicate Discounts – Medicaid number was incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 42 KB).

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Rochester Primary Care Network, Inc. (NY)

340 ID: CH020560

OPA Findings: Incorrect 340B database record –Ineligible sites registered on 340B database.

Sanctions: None.

Corrective Action: Pending.

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Rush University Medical Center (IL)

340 ID: DSH140119

OPA Findings:

  1. Diversion – 340B drugs dispensed to inpatients for prescriptions originating from an ineligible site;
  2. Duplicate Discounts – Entity was billing Medicaid at contract pharmacies and did not notify HRSA of the arrangement.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 147 KB).

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Russell Medical Center (AL)

340 ID: DSH010065

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Samaritan North Lincoln Hospital (OR)

340 ID: CAH381302-00

OPA Findings: Diversion – 340B drug dispensed for prescription originating from ineligible site.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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SeaMar Community Health Centers – Mount Vernon (WA)

340 ID: STD982739

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Sheltering Arms Hospital DBA O’Bleness Memorial Hospital (OH)

340 ID: DSH360014

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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Siskiyou Community Health Center, Inc. (OR)

340 ID: CH100150

OPA Findings: Duplicate Discounts - NPI number not listed on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 246 KB).

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St. Bernard’s Hospital Inc. DBA St. Bernard’s Medical Center (AR)

340 ID: DSH040020

OPA Findings: Diversion – 340B drugs dispensed at contract pharmacy for prescriptions originating from ineligible sites.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 227 KB).

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St. Clare Hospital (WA)

340 ID: DSH500021

OPA Findings:

  1. Incorrect 340B database record – Incorrect contact information for Authorizing Official;;
  2. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions originating from ineligible sites, and written by ineligible providers;

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 112 KB)

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St. John’s Regional Medical Center (CA)

340 ID: DSH050082

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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St. Joseph Medical Center (WA)

340 ID: DSH500801

OPA Findings:

  1. Incorrect 340B database record – Incorrect contact information for Authorizing Official; Registered contract pharmacies without written contract in place.
  2. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions originating from ineligible sites, written by ineligible providers.
  3. Duplicate Discounts - NPI number was incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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St. Mary’s Hospital and Medical Center, Inc. (CO)

340 ID: SCH060023-00

OPA Findings:

  1. Incorrect 340B database record - Outpatient facilities of the hospital were incorrectly registered as a single entity; Incorrect billing address for outpatient facilities;
  2. Diversion – 340B drugs dispensed for prescriptions written by ineligible provider; lack of controls to prevent 340B drugs from being dispensed to inpatients.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 56 KB).

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St. Vincent Hospital

340 ID: DSH320002

OPA Findings:

  1. Incorrect 340B database record – Ineligible sites registered on 340B database; Offsite outpatient facilities were not listed on the 340B database.
  2. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions written at ineligible sites.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending

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Stokes County Health Department (NC)

340 ID: STD27016

OPA Findings: Incorrect 340B database record – Entity was using contract pharmacies not listed on the 340B database; Incorrect primary contact information.

Sanctions: None.

Corrective Action: Database entry corrected; 340B Program policies and procedures revised to address routine review of 340B Program database. Audit closure date: August 4, 2014.

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Sutter Lakeside Hospital (CA)

340 ID: CAH051329-00

OPA Findings:

  1. Incorrect 340B database record – offsite outpatient facilities were not accurately listed, incorrect entries for Authorizing Official information.
  2. Entity did not provide contract pharmacy oversight.
  3. Diversion – 340B drugs dispensed at contract pharmacies for prescriptions written at ineligible sites, not supported by responsibility of care; Entity did not have a mechanism in place to prevent diversion.
  4. Entity was billing Medicaid contrary to information in the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers; Removal of contract pharmacies.

Corrective Action: Public letter to manufacturers (PDF - 115 KB).

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Taylor County Hospital District (KY)

340 ID: DSH180087

OPA Findings:

  1. Incorrect 340B database record - Registered contract pharmacy without written contract in place;
  2. Diversion – 340B drugs dispensed at covered entity and at contract pharmacies for prescriptions originating from ineligible sites; 340B drugs dispensed, not supported by a medical record.

Sanctions: Repayment to manufacturers.

Corrective Action: Public letter to manufacturers (PDF - 18 KB).

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Trinitas Regional Medical Center (NJ)

340 ID: DSH310027

OPA Findings:

  1. Incorrect 340B database record - Closed contract pharmacy remained registered on the 340B database;
  2. Diversion – 340B drugs dispensed to inpatients; 340B drugs dispensed for prescriptions originating from ineligible sites, not supported by responsibility of care; 340B drugs were not properly accumulated;
  3. Duplicate Discounts – Medicaid number was incorrect on the Medicaid Exclusion File.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Truman Medical Center Hospital Hill; Truman Medical Center Lakewood (MO)

340 ID: DSH260048 DSH260102

OPA Findings: Diversion – 340B drugs dispensed at contract pharmacies for prescriptions written by ineligible providers; 340B drugs dispensed for prescriptions written at ineligible sites.

Sanctions: Repayment to manufacturers.

Corrective Action: Pending.

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Uniontown Hospital (PA)

340 ID: DSH390041

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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University of Michigan Hospitals and Health Centers (MI)

340 ID: DSH230046

OPA Findings: No adverse findings.

Sanctions: None.

Corrective Action: N/A

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