Tennessee Pharmacist Indicted for Fraud:
The recent case in Tennessee involving a Pharmacist indicted for fraud should make us all consider a thorough review of all our Pharmacy’s policies and procedures (or perhaps the lack of documentation that every Pharmacy is required to have). Although the purpose of this post is in no way intended to compare honest Pharmacy business owners with the Tennessee Pharmacist who was arrested and charged with TennCare fraud and selling fraudulent prescriptions, we at HCC have always believed in the old cliche “an ounce of prevention is worth a pound of cure”. This is more relevant today than ever in the evolving world of technology that makes having up to date policies, procedures, processes and documentation a mandatory necessity.
The case in Tennessee involves a 76 year old Pharmacy owner charged with 25 counts of TennCare fraud. Following a six month investigation, it became clear that the Pharmacy was billing TennCare for drugs that were never dispensed to patients. As just one example, agents said that TennCare was billed 9 times for a total of $7,857.85 for Abilify (an antipsychotic medication used to treat schizophrenia). Followup during the investigation led the investigators to numerous other violations. Although this is obviously an extreme example of “one thing being looked at leading to another”, the investigators also uncovered controlled substance inventory discrepancies of roughly 195,000 controlled substance pills that were unaccounted for by inventory documentation.
The important conclusion to consider from this case is that when inspectors or investigators are focusing on one area of your business, the potential of uncovering deficiencies in other areas of your practice exists. Being Pharmacists ourselves, we at HCC know that the majority of all Pharmacy owners are extremely honest, hard working individuals who do the best job possible to adhere to all laws, standards and best practices. Yet each of us must ask ourselves: “Am I really doing this? Am I an expert on all the regulations, laws and standards that are constantly changing? Am I qualified to determine if my policies, procedures and documentation are adequate?”. If not, when was the last time that what you do have in place was reviewed by a qualified Compliance Expert or Pharmacy Consultant? If the answers to any of the questions was no, we strongly urge you to call HCC today for a free consultation at 800-642-1652. HCC is a full service Pharmacy Consulting firm that has been in business for over 27 years helping pharmacies plan, prepare and deal with issues before they become problems.