Navigation Links
PCMA: 'Protect Your Pharmacy Week' Should Focus on Safeguarding Part D Anti-Fraud Tools
Date:4/10/2008

New Survey and Ad Highlight Fraud, Waste, and Abuse Problem

Merritt: 'Small Pharmacies Can Be Especially Vulnerable'

WASHINGTON, April 10 /PRNewswire-USNewswire/ -- A new survey of experts responsible for detecting and preventing pharmacy fraud, waste, and abuse in Part D finds that proposals requiring drugstores to be paid twice as fast as other Medicare providers would increase costs and make it more difficult to fight fraud, waste, and abuse, the Pharmaceutical Care Management Association (PCMA) said today. In addition to the new survey, PCMA is also launching a print advertising initiative that highlights how "finding the bad apples isn't easy" in detecting fraud, waste, and abuse and that proposals mandating "prompt pay" would make it even tougher.

"'Protect Your Pharmacy Week' is a good time to focus on safeguarding the tools needed to fight increasingly sophisticated and aggressive fraud tactics. Finding the 'bad apples' isn't always easy and small pharmacies can be especially vulnerable," said PCMA President and CEO Mark Merritt. "Part D plans employ a variety of state-of-the-art techniques when working with pharmacies and other stakeholders to combat fraud, waste, and abuse. Making plans pay drugstores twice as fast as other Medicare providers would increase costs and make fighting fraud, waste, and abuse more difficult."

Survey findings include:

-- Pharmacy Fraud, Waste, and Abuse Is Costly: Approximately 1 percent of prescription costs are likely due to fraud, waste, or abuse. This amounts to hundreds of millions of dollars in unnecessary costs for the Medicare Part D program and its beneficiaries.

-- Part D Plans Use Advanced Techniques to Combat Fraud, Waste, and Abuse: Part D plans use sophisticated software and auditing techniques to identify problematic prescription claims. Most plans screen for fraud, waste, and abuse both before and after a claim is paid. Problem claims can often be detected automatically, but auditors must then analyze the claims and often contact the pharmacy, doctor, or patient for additional information to determine if fraud, waste, or abuse has occurred.

-- Problem Claims Can Be Caught Prior to Payment: Typical examples of fraud, waste, and abuse detected prior to a claim being paid include prescription claims submitted with the improper quantity, improper days supply, improper coding, duplicative claims, and other irregularities.

-- "Prompt Payment" Mandates Would Increase Costs: Accelerated payment cycles would make it difficult or impossible to complete some fraud, waste, and abuse detection efforts that currently occur prior to payments being made. While the majority of payments made on claims involving fraud, waste, or abuse can eventually be recovered, this can be difficult, time intensive, and, in some cases, impossible. This results in increased costs.

-- Independent Pharmacies Tend to be More Vulnerable to Fraud than Large Chain Pharmacies: Unlike independent pharmacies, large chains have centralized billing operations with sophisticated accountability systems in place.

Merritt added: "Medicare's current 30-day payment cycle strikes the right balance between paying pharmacies promptly and protecting the integrity of the program."

-- New Survey: "Prompt Payment " Mandates Would Raise Costs Due to Pharmacy Fraud, Waste, and Abuse

-- New PCMA Print Ad: "Bad Apples"

-- Finding the "Bad Apples": Case Studies of Pharmacy Fraud Waste and Abuse

Available at: http://www.pcmanet.org

PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.

CONTACT: Charles Cote (202) 207-3605


'/>"/>
SOURCE Pharmaceutical Care Management Association
Copyright©2008 PR Newswire.
All rights reserved

Related medicine news :

1. PCMA: CMS Releases Proposed E-Prescribing Standards in Medicare
2. PCMA: New Study on Independent Pharmacy Reimbursements Will Raise Eyebrows on Capitol Hill
3. PCMA: New CBO Analysis Confirms Independent Pharmacy Collective Bargaining Legislation Increases Costs for Consumers and Payors
4. PCMA: 2008 Health Debate Highlights Workable Solutions Like E-Prescribing
5. PCMA: Independent Drugstore Lobbys Prompt Pay Agenda Could Cost Medicare $3.3 Billion Over the Next Decade
6. Survey reveals disparities in skin cancer knowledge, protection among high school students
7. Scientists Develop Natural Protection for Stored Foods
8. Despite overeating, morbidly obese mice gain protection against diabetes
9. Daily Calcium Does Protect Bone
10. Tennessee Faith Leaders Call on Reps. Gordon & Blackburn to Co-sponsor Legislation to Protect Kids from Tobacco
11. Physician Skin Care Specialist Says Proposed New Rules for Sunscreen Products Will Better Protect the Public
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:12/2/2016)... ... December 02, 2016 , ... ... the launch of its 60-day free trial program for all of the company’s ... the offer a truly hassle free experience. , FlexiSpot’s unique desktop risers use ...
(Date:12/2/2016)... ... December 02, 2016 , ... U.S. Surgeon General, Dr. Vivek Murthy, graces ... explains how he was inspired to practice medicine at an early age by his ... more than making diagnoses and prescribing medicine,” he states. “It is about building relationships ...
(Date:12/2/2016)... ... December 02, 2016 , ... Dr. Raffi Hovsepian, a leading ... the 2016 “Guide to America’s Top Plastic Surgeons” for seven consecutive years. The ... education, experience, and professional associations. , One the most frequently honored surgeons ...
(Date:12/2/2016)... ... December 02, 2016 , ... CloudLIMS.com, ... its SaaS LIMS, CloudLIMS Lite. CloudLIMS Lite helps biobanks, clinical, research and testing ... shipping and disposal. The new version is a faster and a more efficient ...
(Date:12/2/2016)... ... December 02, 2016 , ... Sourced from the Isbre Springs beneath the ... its unmatched natural purity of just 6 ppm TDS (Total Dissolved Solids) in addition ... has been available in several ShopRite and FoodTown stores in NJ and received rave ...
Breaking Medicine News(10 mins):
(Date:12/2/2016)... Dec. 2, 2016 The U.S. Food and ... (empagliflozin) to reduce the risk of cardiovascular death in ... disease. "Cardiovascular disease is a leading ... mellitus," said Jean-Marc Guettier , M.D., C.M., director ... FDA,s Center for Drug Evaluation and Research. "Availability of ...
(Date:12/2/2016)... , December 2, 2016 Persistence ... pacemaker market in its upcoming report titled, "Global Market Study on ... Declining CAGR of -1.4% between 2016 and 2024". The global ... in 2015 and this is likely to decline to ... the global cardiac pacemaker market is anticipated to exhibit ...
(Date:12/2/2016)... NEW YORK , December 2, 2016 ... Market Research titled "Global Market Study on Automated Endoscope Reprocessors: ... Register a CAGR of 8.6% Between 2016 and 2024 " the ... 2015 and is expected to expand at a CAGR of ... market valuation of US$ 1,367.6 Mn by 2024. ...
Breaking Medicine Technology: