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

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
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SOURCE Pharmaceutical Care Management Association
Copyright©2008 PR Newswire.
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