With the U.S. Department of Health and Human Services Office of Inspector General’s (OIG) recent focus on telemedicine fraud, pharmacies may be wondering what their obligations are when determining a prescription’s authenticity – especially when it comes to whether a valid prescriber/patient relationship exists.
The winter months have many pharmacies mailing prescriptions to their snowbird patients who leave their northern nests for more hospitable climates.
Prescriptions for medications whose dosing is standardized in the industry often come with directions that simply state, “Use as directed.”
In September 2022, the U.S. Department of Health and Human Services Office of Inspector General (OIG) put out a report on program integrity risks concerning Medicare telehealth services during the first year of the COVID-19 pandemic.
Humana has recently sent out audits to pharmacies with a subject line stating Review of claim(s) billed after member’s deceased date.
Diazepam rectal gel continues to confuse prescribers and pharmacies alike when it comes to how a prescription is written and then ultimately filled and billed.
Anytime you dispense a quantity different from what was prescribed, you should note why.
The new inhaler was not an exact replacement of the old one. What happens if the plan will not allow a 20-day supply?
Make sure you have good documentation of the conversation with the prescriber’s office to successfully pass an audit that may occur years later.
This partnership was designed to allow both companies to operate independently with ESI providing services to Prime, including performing some audits.
