There might be a problem with duplicate Medicare payments for hospice patients’ drugs – but no one is really sure.

That’s the result of a new OIG report published July 3. It shows that Medicare Part D paid some $26 million for hospice beneficiaries’ prescriptions which likely should have been covered under the hospice per diem payments instead. In addition, beneficiaries paid some $3 million in copayments for those drugs, which wouldn’t have been necessary if the drugs fell under the per diem rate.

The affected drugs include analgesic, anti-nausea, laxative and anti-anxiety medications. The reason those would be covered under the per diem payment is because they’re usually used to treat symptoms that go hand-in-hand with terminal illness, the report says.

The reason nobody really knows the extent of the overlap problem is a lack of oversight on the part of CMS as well as Part D sponsors, the OIG argues. CMS’ response to the report, on the other hand, claims the fact that the OIG didn’t find a problem means one doesn’t exist. CMS makes specific mention of the OIG’s “elaborate research methodology.”

The upshot: CMS declined to go along with the OIG’s recommendation that it step up oversight of drug payments for hospice beneficiaries. It does agree to educate hospices, Part D sponsors and pharmacies about the danger of overlap.

In an additional bit of back and forth, the OIG responds to CMS’ response by arguing that its preliminary audit work showed a problem existed and that CMS officials endorsed the aforementioned “elaborate research methodology.”