So, if you're beyond the PBM return to stock timeframes, forgetting to reverse those claims in within an appropriate time, or just putting them back in stock and not reversing them at all. Sometimes pharmacies can get caught up in not reversing claims. And so, pharmacies that are just in existence merely to bill and fill, totally not filling any claims or just billing claims and so false or phantom claims. So, everything that you bring in is all profits to the scheme. It's one of the easiest kinds of get rich quick schemes out there because you're not dispensing product, so you don't have to purchase it. First one kind of comes around false or phantom claims. There are a lot of situations that occur when we talk about and I think, probably three elements that I see in fraud when we look at Department of Justice and OIG settlements. And we're trying to educate and let members know here's the things that we're seeing, here's what to be aware of. And I fully believe in the saying, “One bad apple can spoil the bunch.” These individuals make it harder for those working honestly and ethically to continue to conduct business because PBMs, it forces PBMs to conduct audits to find and root out these bad actors and unfortunately, good pharmacies get caught up trying to do things whether they fail to keep good documentation or keep good records. Theide: I think one of the components that we always have as part of our seminars is sharing examples of pharmacies that, we’ll call them bad actors, that are really making it difficult for the good players in the industry, the honest ethical pharmacists that are grinding away trying to make a living and then we have bad actors. So, can you talk a little bit more in depth about some of the instances of fraud that have happened that you've seen that have necessitated an increase in PBM audits? So, a lot of what we talked about is going to be focused on that. We recently covered a presentation that you gave at NCPA Annual Meeting this year on, you know, PBM audits and kind of attacking those collaboratively. So, it's great to be here and share some of our guidance and all the things that we're experiencing currently.ĭrug Topics®: Awesome. We work with more than 5000 pharmacies across the US helping them navigate the audit process from beginning to end, including appeals and proactive guidance and advice. We've been in business since 1993, helping independent community pharmacies with their insurance audits, and we also have a fraud, waste, and abuse HIPAA compliance component. I'm the president of PASS National PASS stands for the pharmacy audit assistance service. I wanted to turn things over to you and let you get started with an introduction to our audience. Click here to learn more about Prescryptiveĭrug Topics®: Hey Trent, thank you so much for joining us today.
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