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Drugstore Lobby Looks for 'Free Pass' to Avoid Fraud, Waste, and Abuse Detection
Date:8/3/2011

he Drugstore Lobby vs. Employers
  • Click here to view the new PCMA ad: "Spotting Bad Apples Isn't this Easy…Why Make it Even Harder to Detect Pharmacy Fraud, Waste, and Abuse?"

  • Examples of pharmacy fraud, waste, and abuse that can be detected include:

    • Phantom Prescriptions: Getting paid for prescriptions that are not dispensed;
    • Phantom Pharmacies: Fraudulent operations which are not pharmacies, but submit claims to payers;
    • Diversions: Diverting narcotics prescriptions for sale in the illegal drug market;
    • Overcharging: Charging payers for higher cost drugs when lower cost drugs are dispensed; and
    • Coding: Manipulating the coding and payment system to receive higher reimbursements.

    Independent Drugstores vs. the Anti-Fraud Community

    In an effort to carve drugstores out of the national fight against health care fraud, independent drugstores are demanding new laws (The Pharmacy Competition and Consumer Choice Act of 2011, H.R. 1971/S. 1058) to limit the use of audits and other tools used to detect pharmacy fraud. A white paper published by NHCAA raises serious questions about the kind of legislative proposals promoted by the independent drugstore lobby, including:

    • Policies that undermine payers' ability to audit independent pharmacies suspected of fraud ("Audit Reform" policies). NHCAA supports measures that would "protect the integrity of health care audits by giving auditors more discretion and flexibility to perform their duties" and notes that "on-site audits have revealed indications of fraud such as nonexistent pharmacies, unexplained stockpiles of controlled substances, mismatc
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    SOURCE Pharmaceutical Care Management Association
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