Salud federal niega rembolso millonario al local
PRDH asserts that disallowing this large amount of money puts it in "more than a
precarious position as it has no means to be able to claim or bill any entity which might
have had at the time the primary payment responsibility" for paying for these
prescriptions. Id. at ¶ 15. It asserts further that the disallowance "ultimately frustrates
the whole purpose of the Grant by preventing HIV/AIDS patients from access to life
saving medication as we cannot sustain a similar program with only State funds." PRDH
Reply Br. at ¶ 14. According to PRDH, this disallowance will put a "burdensome load on
the Agency" and force it "to put patients with HIV/AIDS medications necessities on
waiting lists further jeopardizing the health of this population."
"HRSA does not dispute these allegations. However, the Board lacks authority to grant
PRDH’s request for what is essentially equitable relief. West Virginia Dept. of Health
and Human Resources, DAB No. 2185, at 20 (2008); Utah Dept. of Health, DAB No.
2131, at 23 (2007). We must uphold a disallowance if it is supported by the evidence of
record and is consistent with the applicable statutes and regulations. West Virginia, DAB
No. 2185, at 20, citing 45 C.F.R. §§ 16.14, 16.21. As explained above, we conclude that
this disallowance satisfies those criteria.
Finally, to the extent that PRDH is arguing that the disallowance "ultimately frustrates
the whole purpose of the Grant,” we note that the purpose of ADAP was frustrated here
because PRDH did not comply with the payer of last resort requirement. It needlessly
spent limited ADAP funds for prescriptions for which payment could reasonably be
expected to be made by other payers, principally GHIP.
Conclusion- For the preceding reasons, we uphold this disallowance in full."