Audit Risks: Medication Home Delivery
Many independent pharmacies offer unique services to their patients, such as house charge accounts and medication delivery, to provide a better customer experience.
Entries by Eric Hartkopf, PharmD
California Pharmacy Charged in $300 Million Medicaid Fraud Scheme
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.
Rethink Corrective Action Plans
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.
Audit Risk: Prescriber Scope of Practice and Treating Self or Family
Everyone knows that PBMs do not perform “random” audits, nor do they select “random” claims in these audits.
2024 National Health Care Fraud Takedown
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.
Diabetic Test Strip Authorized Distributors
Independent pharmacies continue to receive threatening letters from LifeScan and an affiliated law firm on a monthly basis.
How to Safeguard Your Pharmacy from Fraudulent Electronic Prescriptions
PAAS National® has recently assisted pharmacies who received fraudulent electronic prescriptions from prescribers that had their electronic prescribing credentials hacked or stolen.
Commercial Claims Reimbursed through Embedded GoodRx® Discount Cards
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.
OptumRx Auditing for Medical Supplies Billed Under Medicare Part D
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.
V-Go® All-In-One Insulin Delivery Patch
The V-Go® all-in-one insulin delivery patch is a disposable device approved for use in patients with Type 2 diabetes.
