Tennessee Pharmacist Indicted for Fraud

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.


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Pharmacy HIPAA Violations Rise – Develop Policies and Procedures

Pharmacy HIPAA Violations Rise – Develop Policies and Procedures:

Pharmacy HIPAA violations are on the rise again and the primary reason centers around the ever increasing digital and electronic platforms (such as EMR and other digital patient data records). There definitely has been increased scrutiny by the OCR in looking into patient privacy violations (and also increased penalties being seen including substantial fines and strict documentation and retraining mandates). The Health Insurance Portability and Accountability Act of 1996 privacy rule centers around the protection of patient confidentiality, and a new system of routine audits for major healthcare providers began this year (according to Law360).

Pharmacy Times had a recent article citing the Major pharmacy chains as the biggest HIPAA offenders, with two of the nation’s leading pharmacy chains (CVS and Walgreens) having the most violations. A ProPublica investigation revealed that CVS had a reported 204 complaints and Walgreens 183. Other pharmacy chains also made the top 10 list of offenders, with Walmart being reported 71 times and Rite Aid pharmacy 48. The most commonly reported violations included pharmacy staff speaking far too loudly, compromising patient confidentiality, and dispensing prescriptions to the wrong patients. It is important to note that the infractions led to 30 financial penalties (plus a lot of bad publicity!).

Large Hospitals have recently been fined extremely large financial penalties for more serious transgressions. A prime example is the $750,000 fine that University of Washington Medicine had to pay out in December 2015. According to the HHS, the Hospital was fined following a major patient records leak with well over 90,000 patient records compromised by malicious malware that was opened in an email by a nurse. The records contained highly sensitive patient information such as patient birthdays and Social Security numbers. The biggest reason cited for the fines was actually the fact that they failed to produce, develop and implement a comprehensive set of policies and procedures to comply with the HIPAA rules. It was also noted that the staff was not provided adequate training in dealing with HIPAA requirements. Keep in mind also that along with the fines, bad publicity results in business severely suffering in almost all scenarios!

Does your Pharmacy have policies and procedures regarding HIPAA requirements in place? If so, when was the last time that they were reviewed by a qualified HIPAA Compliance Expert or Pharmacy Consultant? Additionally, do you provide adequate and documented training yo your staff regarding HIPAA? If the answers to any of these questions is no, we strongly urge you to call HCC today for a free consultation at 800-642-1652.

Healthcare Consulting is a full service Pharmacy Consulting firm that has been in business for over 27 years. HCC has been helping pharmacies plan, prepare and deal with issues such as HIPAA compliance since 1989. Just a few examples of our services include:

– Development of Policies and Procedures (including HIPAA Compliance and Documentation)
– Employee Training
– Patient Consultation Documentation
– Pharmacy Management Consultation

Although we all hope that we will never personally deal with such HIPPA violations, be prepared! HCC’s motto has always been that the old cliche “an ounce of prevention is worth a pound of cure” especially applies to running a Pharmacy business. Contact us on line or call us today for a Free Consultation at 800-642-1653 to discuss how we can help you.


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Consulting For Online and Internet Pharmacies – Policies & Procedures

Online Pharmacies have been a controversial issue for decades now. The recent charges against a Pharmacy owner and a doctor regarding an illegal Internet “scam” they ran to make millions by distributing medications to patients without valid prescriptions again brings this topic to national attention. The fact that the “scam” went on for almost 4 years is leading many legislators and consumers to voice their concerns for both better regulations and monitoring regarding Internet Pharmacies.

The basis of the indictment is that patients received prescription drugs through RX Limited and other websites by simply filling out online medical forms and then hitting the “submit” button on a website! Then pay and check out and the prescriptions arrive. Utilizing both his Anaconda Pharmacy and his MEDS 2 GO Pharmacy businesses, Philip E. Michael II, of Alum Creek, West Virginia, filled and shipped Rx drug orders to patients throughout the United States without valid prescriptions. After patients selected desired drugs and submitted an online medical questionnaire, the website would send it to doctors such as Eutan Laing, of Piscataway, New Jersey, who has also been charged. The drugs would then be dispensed and shipped without having an adequate patient history, performing any patient exams, nor using any appropriate diagnostic or laboratory testing. Then, the invalid prescription would be filled by MEDS 2 Go or Aracoma and shipped to customers.

According to the National Association of Boards of Pharmacy (NABP), 97% of almost 11,00 online pharmacies reviewed by the board are operating in conflict with pharmacy laws and practice standards. Violations have included stolen personal and financial information, virus-laden spam e-mails and even online pharmacies selling pills that contain drywall or rat poison. Some of the issues surrounding Internet pharmacies were highlighted by a case in 2012 involving a couple of Canadian businessmen who sold counterfeit Avastin, a cancer drug developed by Roche Holding AG, to Americans patients. Some of these counterfeit medications even showed up in medical clinics. In 2014, FedEx received an indictment from a federal grand jury for drug trafficking charges after delivering drugs for nearly a decade from Internet Pharmacies operating illegally. As recently as early March, there was a $2 million settlement paid by one Missouri pharmacist who distributed painkillers like Fioricet online to patients he had never seen for an in-person consultation.

In this particular case. Michael and Laing have been charged with a list of criminal charges that is almost too long to even comprehend:
– Internet pharmacy conspiracy to distribute misbranded drugs.
– Distributing misbranded drugs
– Mail fraud conspiracy
– Wire fraud conspiracy
– Health care fraud
– Engaging in the unlicensed wholesale distribution of prescription drugs
– Defrauding a health care benefit program

If you plan to open an Internet Pharmacy or currently operate an Online Pharmacy, the time to make sure that you are doing everything right and legally is now! The security requirements alone that are required are vastly complex and complicated and even without intentionally meaning to, violations such as aggravated identity theft have been filed against several Internet Pharmacies.

As always, please contact us here at HCC if you have questions regarding establishing or running an Internet Pharmacy online. With over 27 years in the Pharmacy Consulting business, HCC can assist with expert advice in any area of your pharmacy business or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Call us today at 800-642-1652 for a free consultation.

 


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Medical Marijuana in Florida – Policies and Procedures/Pharmacy Consulting

Medical Marijuana in Florida – Policies and Procedures:

Medical marijuana in Florida has been a hot topic since Surterra Therapeutics announced in August that it would open a wellness center and sell cannabis in the USF area of Tampa. Although the company planned only to sell medical marijuana low in THC, the approval by the Florida legislature set the precedent for this in 2014 by stipulating exactly what can be dispensed to cancer patients and patients with seizures who choose to utilize medical marijuana as part of their treatment regimens. It is also important to take note that Surterra Therapeutics plans to distribute a “higher grade” dosage to terminally ill patients after approval of another Florida law passed in early 2016. Surterra partners with Homestead-based Alpha Foliage and is one of 6 Florida approved companies regarding marijuana dispensing (to see the entire list visit the Florida Health Department’s website).

The question of whether to participate in the Medical Marijuana Dispensing Program is not what HCC wants to debate here. It is a fact that the laws have now allowed for this. It is also projected to be greatly expanded, increased and profitable. What HCC wants to stress is that if you choose to participate…. do it right! Obtain Pharmacy Consulting before you begin dispensing. Having Policies & Procedures in place will ensure that problems down the road will be reduced. Everyone agrees that the State will “closely observe” how the dispensing companies control supplies, document and keep records. As HCC has been saying for over 27 years: an ounce of prevention is worth a pound of cure!

Healthcare Consultants is a leading national Pharmacy Consulting company offering expertise in all areas of pharmacy consulting. Known for being one of the nation’s leading pharmacy staffing companies for over two decades, Healthcare Consultants has been in the business of Pharmacy Consulting for over 25 years now. HCC is in the business of helping pharmacists establish, run, improve and make their businesses profitable. HCC is known nationally as one of the industry leaders in providing a full range of professional pharmacy consultation services to its vast array of clients. Owned and operated by pharmacists, Healthcare Consultants can provide proven expertise and experience in all facets of pharmacy operations, including retail, hospital and specialty pharmacy venues.

No matter what your pharmacy consulting needs may be, you can be assured that the experienced HCC staff has helped others with the same issues before. Let HCC and their expert team of pharmacy consultants help you solve your problems too! In today’s environment of a constantly changing landscape in the pharmacy business, let an experienced, proven Pharmacy Consulting company provide you with the assistance you may need. We have a professional full-time staff of pharmacy consultants with a proven track record in every area of pharmacy operations.

Just a few of the pharmacy consulting services that HCC offers include:

– Pharmacy Performance and Efficiency Enhancements
– Pharmacy Business Management Consulting
– Pharmacy Business Planning
– Pharmacy Start-up Consulting and Implementation
– Interim Pharmacy Management
– Policy and Procedure Development and Review
– Compliance Review
– Pharmacy Exit Strategies

If you have questions regarding virtually any area of your pharmacy business or practice, we urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Call us today at 800-642-1652 for a free consultation.

 

 

 


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