Ensuring Audit Readiness: What PBMs Look for in Signature Logs and Proof of Delivery
One of the most common questions PAAS National® receives from our members is: what are the requirements for audits when signature logs are requested.
Entries by Dana Westberg, CPhT
2024 Self-Audit Series #5: Topical Prescriptions
Topical medications are easy audit targets, especially with the rising costs of some of these medications.
2024 Self-Audit Series #4: Transferred Prescriptions
Making sure your transferred prescriptions are complete can be one of the easiest audit recoupments to prevent.
Pharmacy Owner’s Involvement in Fraud Scheme Leads to 4-Year Prison Sentence
The Department of Justice recently announced the sentencing for a New York pharmacy owner. A four-year prison term, three years extended supervision, and paying back restitution of more than $6 million dollars, is the outcome for this owner based on his involvement in a Medicare and Medicaid fraud scheme.
OptumRx Targeting Medications Requiring Dispensing in Original Containers
Recent audit results coming into PAAS National® are showing OptumRx auditors have their sights set on several medications that are required to be dispensed in the original container.
2024 Self-Audit Series #3: Invoice Audits
The number of invoice audits continues to rise from Medicaid, and PBMs, across the board. This investigational audit is a way to potentially identify false or phantom claims. Auditors will reconcile the claims billed by a pharmacy during a certain timeframe, with the purchases made.
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.
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.
