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What Is a Pharmacy Audit?

Posted on in Pharmacy License Defense

Illinois license lawyerThe process to become a licensed pharmacist takes much time and effort, and to own a pharmacy comes with more expectations and requirements. If you own a pharmacy, you may expect to have pharmacy compliance audits run from time to time. There are many factors in pharmacy audits that you need to know in order to meet guidelines to keep the pharmacy intact.

Definition of Pharmacy Audit

A pharmacy audit is a formal review of operations and processes to make sure that pharmacies are compliant with pharmacy regulations and other related agreements. The pharmacy audit process can come in many different types, including desktop, onsite, prepay claims review, and investigational pharmacy audits.

  • Desktop pharmacy audits are done in-house on claims that have been adjudicated, also known as Documentation and Verification Audits (D&V).
  • Onsite pharmacy audits occur when an auditor reviews adjudicated claims against a prescription onsite at the pharmacy, and policies and procedures will be thoroughly reviewed with an interview with a senior pharmacist. A report will be completed, outlining any discrepancies regarding the pharmacy.
  • Prepay claims review pharmacy audits occur when adjudicated claims are audited before a payment is made, with the objective to identify claims with dosage and payment discrepancies and resolve them before payment. Unlike other types of pharmacy audits, claims are not adjusted, reversed, or stopped at a point of sale.
  • Investigational pharmacy audits are more extensive than a desktop or onsite pharmacy audit. Depending on the situation of a discrepancy being researched, the complexity of the investigational pharmacy audit process may vary.

Onsite pharmacy audits typically take no more than 60 days to close, depending on the circumstances and outlying discrepancies. Desktop audits, however, usually take around 90 days to close, again depending on the given circumstances.

If pharmacies do not comply with regulations in the auditing process, they may face a penalty fee, corrective action to be taken, or even suspension.

Call a DuPage County Pharmacy Audit Lawyer

It is very important to know what to expect in a pharmacy compliance audit. At the Law Offices of Joseph J. Bogdan, LLC, we have over 17 years of knowledge and experience in pharmacy license law. Attorney Joseph J. Bogdan is also a registered pharmacist, so he thoroughly understands pharmacy audits and how they work. To schedule a free consultation, please call a Lisle IL pharmacy license attorney at 630-310-1267 for effective legal representation.

 

Sources:

https://mp.medimpact.com/pharmacyportal/PDF/IP_Guide_Appeal.pdf

http://www.pharmacytimes.com/contributor/steve-leuck-pharmd/2016/07/pharmacy-compliance-audits-what-pharmacists-can-expect

Illinois State Bar Association DuPage County Bar Association Illinois Pharmacists Association American Pharmacists Association 10.0Joseph John Bogdan
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