A recent Department of Justice press release outlined a settlement with Walgreens for nearly $107 million for False Claims Act violations related to claims billed to government programs that were never dispensed.
Many independent pharmacies offer unique services to their patients, such as house charge accounts and medication delivery, to provide a better customer experience.
The US Attorney’s Office for the Central District of California recently issued a press release outlining charges against a pharmacist for the submission of more than $300 million in fraudulent claims to the state Medicaid Program (Medi-Cal) for medications that were not medically necessary, where drugs were not dispensed to patients, and where prescriptions were obtained through illegal kickbacks.
PAAS National® analysts continue to see PBMs demand pharmacies complete formal Corrective Action Plans (CAPs) in response to negative audit outcomes; particularly from MedImpact, OptumRx, and Caremark.
Everyone knows that PBMs do not perform “random” audits, nor do they select “random” claims in these audits.
On June 27th the U.S. Department of Justice (DOJ) issued a press release outlining a National Health Care Fraud Enforcement Action that resulted in 193 defendants charged, including doctors, nurses and pharmacists, and over $2.75 billion in false claims.
Independent pharmacies continue to receive threatening letters from LifeScan and an affiliated law firm on a monthly basis.
PAAS National® has recently assisted pharmacies who received fraudulent electronic prescriptions from prescribers that had their electronic prescribing credentials hacked or stolen.
Pharmacies have been reaching out to PAAS National® with concerns about claims being reimbursed through an embedded discount card (e.g., GoodRx®) rather than a patient’s commercial insurance plan benefit.
In March 2024, PAAS National® analyst assisted nearly 100 pharmacies with desk audits from OptumRx requesting documentation related to claims for medical supplies (primarily alcohol swabs) that were processed by OptumRx under the Medicare Part D benefit.
