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How to avoid a pharmacy audit

On Behalf of | Jun 6, 2019 | Firm News |

Opioid abuse is a real crisis in America. Due to the soaring rates of addiction and overdose, the U.S. Department of Health and Human Services declared the epidemic an emergency for public health in 2017 and created a plan to increase education, support and safety.

A serious side effect of the federal response to the opioid problem, as well as healthcare fraud in general, is a closer look at prescriptions. The goal is to lower opioid use, so any triggers of improper drug distribution can lead to the audit of your pharmacy. Watch out for these common actions to prevent criminal charges of abuse or fraud.

High dispense rate of controlled substances

Naturally, you will fill prescriptions for many controlled substances, but the numbers should be typical of a pharmacy of your size and in your area. Large quantities will be a red flag to authorities, and they may think you are filling fake prescriptions or keeping the drugs to use or sell on your own.

Improper ratios

High numbers may be even more of a trigger when you compare them to other relevant numbers. For example, did the number of prescriptions exceed the supply you had in stock or the program limitations?

Fishy prescriptions

It is your job to ensure you only accept valid prescriptions. Failing to check them can cause insurance providers to refer you for an audit. Make sure the medical need is real and appropriate for the medication. Also verify that the provider has the authority to write the prescription in question and that the patient has not been jumping from doctor to doctor to maintain access to the drug. It may be unfair that you can face charges for someone else’s deliberate mistakes, but it best to cover your bases.

Preventive steps to take

Your best line of defense is having complete and accurate records of all prescriptions, patients, insurance companies and interactions. The more evidence you have to prove you did no wrong, or at least did it unintentionally, the better your outcome will be. Properly training your staff and staying aware of their activities can also keep your pharmacy out of trouble.