Pharmacy Audits

Pharmacy AuditsA recent pharmacy audit in Colorado resulted in a payment of almost $64 million in a settlement by DaVita, Inc. DaVita is known for being a major provider in the dialysis field and in the treatment of patients with severe and chronic renal diseases. The company additionally owns a division that supplies numerous pharmaceuticals to both patients and providers. After a recent audit of their pharmacy division, DaVita was accused of numerous billing improprieties in regards to several federal government health care programs. The pharmacy division also was cited for paying what are considered illegal financial inducements to DaVita’s patients. As reported by the Kansas City Star, the United States Justice Department accepted a settlement of $63,700,000 from the company after the pharmacy division’s audits resulted in the criminal activities coming to their attention.

DaVita’s pharmacy division was alleged to have billed Medicaid, Medicare and several other federal programs for prescriptions and drugs that never actually were dispensed or delivered to any patients. Additionally, they were cited for billing improprieties regarding medications that were returned unused and also  for prescriptions that didn’t satisfy program requirements. DaVita also was cited for its pharmacy being in violation of federal “anti-kickback” laws for paying illegal financial incitements to patients.

Be Prepared For A Pharmacy Audit

In the case cited above, DaVita’s management team admitted to ignorance in regards to the practices that the audit of the pharmacy division revealed. Yet according to the US Department of Justice, DaVita was “guilty as charged and responsible for the actions of all of their employees and staff”. Don’t let this happen to you.

Pharmacy audits are being seen more frequently than ever before and many experts state that it’s a safe assumption that your pharmacy will be audited every two years at a minimum. In today’s world of Big Data and Social Media, an audit that reveals improprieties in your pharmacy is public information and can literally cost you tens of thousands of dollars, even if you are able to combat any allegations that are made and prove your innocence. The bad publicity alone that we have seen many pharmacies experience leads to both the loss of customers and revenue that could easily have been avoided. The key to avoiding a bad inspection or audit? Get prepared NOW!

Types Of Pharmacy Audits

Pharmacy compliance audits assess a pharmacy’s level of compliance in regards to procedures stipulated by regulatory or contractual arrangements. Basically pharmacy compliance audits can be placed into two categories:

  1. Third Party Provider Audits – A pharmacy that operates as a contract provider of prescription services for a third party is subject to a clause in its provider agreement that allows an audit of the pharmacy’s prescription records. This is inclusive of “hard” copy Rx’es, patient signature logs, computerized records of refills, plus all of the pharmacy’s invoicing records.
  2. Regulatory Agency Audits – Pharmacies are subject to audits by both state or federal licensing agencies such as their geographical State Board of Pharmacy and federal agencies such as the FDA and DEA.

Be Proactive and Get Prepared Now

HCC’s is a nationally renowned Pharmacy Consulting firm that has been helping pharmacy owners be prepared for audits since 1989. With over 28 years in the business, our in-house consultants have the experience required to assess your business and make recommendations in regards to any improprieties in your pharmacy operations. Our regulatory experts can perform mock inspections and identify areas of potential violations, weaknesses and concern. Our consultants will, upon completion of the audit, prepare both a Gap Analysis and a Corrective Actions Plan and then discuss these with you and your team. If significant issues are found, our consultants are available to assist in the implementation of the corrective actions and perform a re-inspection to confirm compliance. HCC will also make sure that your pharmacy’s Policies and Procedures are current and up to date as required by inspectors.

Our experts are also available to review your prescription filling and billing processes to identify areas that may put you at risk of a payer audit and recoupment demands. HCC’s consultants will work with you and your team to correct areas of concern and develop risk mitigation strategies to prepare your pharmacy for the unexpected, but inevitable, audit.

Don’t wait until you get the audit notice or find the auditor at your doors. Known nationally as one of the industry leaders in providing a full range of professional pharmacy consultation services to its vast array of clients, HCC is owned and operated by pharmacists. Healthcare Consultants can provide proven expertise and experience in all facets of pharmacy operations, including retail, hospital and all specialty pharmacy venues. Contact us online or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.


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