Navigation Links
PCMA: Anti-Fraud Group Spotlights Policies that Promote Health Care Fraud and Abuse
Date:3/2/2011

WASHINGTON, March 2, 2011 /PRNewswire-USNewswire/ -- As the U.S. House of Representatives Ways and Means and House Energy and Commerce Committees and the U.S. Senate Finance Committee all hold hearings today on combating health care fraud, waste, and abuse, an analysis that examines the "Seven Guiding Principles for Policymakers" to fighting health care fraud invites new questions about legislative efforts to reduce accountability and oversight of independent drugstores, the Pharmaceutical Care Management Association (PCMA) said today.

"Unfortunately, some policies meant to help independent drugstores merely reduce accountability and promote fraud, abuse, and wasteful spending.  It's bad policy to make private payers partner with independent drugstores that are suspected of fraud, can't be effectively audited, or have been banned from federal programs," said PCMA President and CEO Mark Merritt. 

The white paper was published by the National Health Care Anti-Fraud Association (NHCAA),  the leading national organization focused exclusively on combating health care fraud.  The "Seven Guiding Principles for Policymakers" seek to address the estimated $70 to $234 billion in annual financial losses resulting from fraud throughout the health care system and warns policymakers to avoid policies that could undermine fraud fighting efforts. 

Specific questions should be raised about the following legislative proposals promoted by the independent pharmacy lobby:

  • Policies that undermine authority across Medicare to suspend payments when there is suspicion of fraud.  The ability to stop fraud before paying a claim is more effective and more efficient than relying on paying first and then chasing after claims that are later found to be fraudulent.  Congress should extend to Medicare Part D and independent drugstores the recently enacted statutory authority Congress provided in Medicare Parts A and B to suspend payment to health care providers upon a credible allegation of fraud, waste, or abuse. 
  • Policies that reduce payers' time to verify pharmacy claims before payment ("Prompt Pay" policies).  NHCAA states: "if claims are not rushed through the payment process, auditors and investigators will have more opportunities to detect attempts at fraud before they come to fruition."  So-called "prompt pay" laws in Medicare Part D that mandate rapid payment to independent pharmacies reduce the time available to detect pharmacy fraud, waste, and abuse.
  • Policies that make payers partner with pharmacies that are banned from federal programs ("Any Willing Pharmacy" policies).   Legislation that would force plans to include in their networks pharmacies that have been banned from federal programs "runs counter" to preventing fraud, according to NHCAA.  This low bar would allow admission for pharmacists "even if they have records of harmful prescription errors or a high number of consumer complaints."
  • 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." Unfortunately, legislation championed by the independent drugstore lobby would instead grant pharmacies (even those with wasteful or abusive practices) an advance notice "heads up" before performing audits. 

PCMA represents the nation's pharmacy benefit managers (PBMs), which improve affordability and  quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 200-plus million Americans.


'/>"/>
SOURCE Pharmaceutical Care Management Association
Copyright©2010 PR Newswire.
All rights reserved

Related medicine technology :

1. PCMA: Independent Drugstore Lobby Continues Disclosure Double Standard Transparency Campaign
2. PCMA: Ohios Medicaid Program Could Save $135 Million
3. PCMA: Focus on Patients, Not Profits, in Medicaid Pharmacy
4. PCMA: Florida Could Reduce $462 Million in Wasteful Medicaid Pharmacy Spending
5. PCMA: Some Drugmakers Lobbying to Limit E-Prescribing of Generics, Drug Safety Checks
6. PCMA: Generics, Mail-Service Pharmacy Recognized as Ways to Reduce Costs for TRICARE Program
7. PCMA: Mississippis Secret Prescription Drug Tax Will Raise Costs
8. American Association for Homecare Proposes Strong Anti-Fraud Measures in Medicare, Applauds HHS Testimony Today That Pledges to "Stop Fraud Before it Starts"
9. Durable Medical Equipment Community Supports Tough Anti-Fraud Measures, Corrects Persistent Myths
10. Baxter and The Alzheimers Disease Cooperative Study Group to Pursue a Phase III Study of Gammagard Liquid in Patients With Alzheimers Disease
11. HistoRx and Radiation Therapy Oncology Group Initiate Brain Tumor Biomarker Research Partnership
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:7/15/2017)... , July 15, 2017 Enterin Inc., a ... treat Parkinson,s disease (PD), today announced the completion of a ... investors New Ventures III, as well as the participation of ... absolutely thrilled to have the support of New Ventures III ... investors as validation of the potential of our platform technology ...
(Date:7/14/2017)... It should come as no surprise to anyone that ... of a crippling opioid epidemic. According to the Center ... deaths from opiate-based medications has quadrupled, Says, Dr. David ... 2001 to 2015". During this time, the prescription rate for ... a compelling link between prescription and eventual addiction. The problem ...
(Date:7/13/2017)... 13, 2017 RK Logistics Group, Inc. was awarded ... for its Fremont, CA headquarters facility ... Tri-Valley and San Jose for hi-tech, ... Fremont , with its Fremont Innovation District, is excited ... a powerful resource to the hundreds of biotech, pharma and ...
Breaking Medicine Technology:
(Date:7/24/2017)... ... July 24, 2017 , ... Puregraft, ... systems announces the issuance of United States Patent Number 9,695,398 (the '398 patent) ... technology. The '398 and '324 patents cover methods and systems for optimizing ...
(Date:7/24/2017)... ... July 24, 2017 , ... ... in National Harbor, MD. This year's theme focuses on the new ISO/IEC 17025 ... for quality and integrity in testing and calibration will be changed. , ...
(Date:7/24/2017)... , ... July 24, 2017 , ... ... sleep management solution focused on delivering end-to-end sleep health care at scale, ... Recent literature shows that adherence rates for positive airway pressure (PAP) therapy, the ...
(Date:7/24/2017)... ... , ... A Southern California-based author has released a new book which details ... overcome them. “Forbidden Memories: A Memoir,” by author Michelle V. Madsen, highlights the author’s ... , In “Memories,” readers get a firsthand look at what Michelle has been through ...
(Date:7/24/2017)... ... July 24, 2017 , ... Committed to eliminating ... enrolled over 100,000 children in their treatment program. Clubfoot is a pervasive problem ... where treatment is limited or non-existent. Without intervention, these children are destined to ...
Breaking Medicine News(10 mins):