Desk Audits for Worker’s Compensation Claims

PAAS National® analysts have recently seen an increase in desk audits for worker’s compensation claims, mostly performed by Script Care. There has been a high rate of fraud with worker’s compensation in the past and these claims are subject to more scrutiny.

Many states have additional laws specific to worker’s compensation and auditors have often cited prescriptions as “invalid” if prescriptions did not conform to these specific laws.

A few common audit discrepancies include:

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  1. Missing/Incomplete documentation to support DAW-1 claims.
  2. Missing documentation to substantiate that worker’s compensation is the responsible payer (e.g., includes diagnosis code and date of injury).

Upon first receiving an audit contact PAAS (608) 873-1342 so that an analyst can assist you from the start of the audit for the best results.

PAAS Tips:

  • Consider recent fraud against the Department of Labor’s Office of Workers’ Compensation
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    • Former Pharmacy Employee Admits Role in Multi-Million Dollar Illegal Kickback Scheme
Eric Hartkopf, PharmD