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:
Become an audit assistance member today to continue reading this article. As a member, you’ll have access to hundreds of articles and receive our monthly proactive newsletter!
- Missing/Incomplete documentation to support DAW-1 claims.
- 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
- Nine Defendants Sentenced in $126M Compounding Fraud Scheme
- “Compound King” and Wife Sentenced in $21 Million Health Care Fraud Scheme; Fugitive Sought
- Former Pharmacy Employee Admits Role in Multi-Million Dollar Illegal Kickback Scheme
I obtained my PharmD from the University of Wisconsin-Madison School of Pharmacy and worked for a major chain as well as various LTC and independent pharmacies, before coming to PAAS.
I am passionate about learning and teaching. I strive to learn something new about PBM audits every day, so that PAAS can be more knowledgeable to better serve our members! In 2018, I started traveling to state pharmacy conferences to present audit seminars and meet our wonderful members in person.
- Caremark Notice of Breach – Aberrant Practices and Trends - April 20, 2024
- Caremark Invoice Audits – Purchases from Other Pharmacies - April 10, 2024
- Qualified Medicare Beneficiary (QMB) Program - April 2, 2024
