High AWP Omeprazole leads to $2.3M Medicaid Fraud Case
An Ohio pharmacist and owner of four pharmacies, along with a technician, have been found guilty by a federal jury for Medicaid fraud to the tune of $2.3M dollars.
Entries by Dana Westberg, CPhT
2024 Self-Audit Series #2: DAW Codes
Prescriptions flagged for incorrect or invalid DAW codes is a discrepancy we have seen increase notably on PBM audit results.
2024 Self-Audit Series #1: Insulin Prescriptions
These articles can be an excellent training tool for new employees, and a great refresher for all pharmacy staff, to avoid audit discrepancies.
Dosing Increments for Insulin Pens
While insulin pens allow ease and convenience for diabetic patients, they also come with increased audit risks, for a variety of reasons, including dosing.
Inventory Purchase Reminders for Successful Audits
With a 29% increase in PBM audits in 2023, PAAS National® wants to help you avoid PBM scrutiny, especially when it comes to drug procurement.
Tip to Federal Agents Leads to Jail Time for Pharmacy Owner
The Department of Justice announced a Nebraska pharmacist, and owner of two pharmacies, was sentenced to two months of imprisonment, three years of supervised release, and ordered to pay restitution in the amount of $573,000.
Prescriber Statements for Successful Appeal
One of the most common requirements for appealing audit discrepancies is to provide a signed statement from the prescriber to confirm, clarify, or validate a prescription.
All Pharmacies Face Medicare Part A vs Part D Billing Risks, Especially Combo Shops
Pharmacies that service long-term care (LTC) and assisted living facilities (ALF) as well as retail patients, known as “Combo Shops”, may not be aware of the potential recoupment risks from Medicare. PAAS National® wants to inform our members of these risks and how to best avoid them.
Audit Target: Linzess® Prescriptions
PAAS National® analysts have noticed an increase in audits targeting Linzess®.
Auditors’ Latest Trick for Flagging “Misfilled” Prescriptions
PAAS National® analysts are noticing more prescriptions being flagged for recoupment based on “incorrect” instructions for use on the patient label. Pharmacies and PBM auditors have very different perspectives on what a “misfilled” prescription is.
