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IL license lawyerThe world of healthcare is constantly changing. For some pharmacies, keeping up with these changes can be difficult, particularly for independent or small pharmacies. The Centers for Medicare and Medicaid Services (CMS) is the governing body that oversees the practices of different medical professionals who provide services covered by Medicare and Medicaid. One of the goals of CMS is to try to cut down on healthcare fraud and they do this by conducting audits to ensure providers operate within the legal standards. CMS audits can sometimes produce less-than-favorable results that could seriously affect the operation of your pharmacy and its financial wellbeing. Here are a few things you and your employees can do to minimize any errors or inadvertent fraudulent practices:

  • Ensure you are meeting requirements for both non-controlled and controlled substances. When filling and dispensing a prescription, there are certain pieces of information that you must collect, plus a few special pieces of information for controlled substances. To fill a prescription, you must have the prescriber’s signature on the prescription, the name, strength and dosage form of the drug, the directions for use and the number of pre-authorized refills (if any). For controlled substances, the prescriber must have the appropriate authority to prescribe such a drug and the prescriber must manually sign the prescription on the date it was issued.
  • Follow proper procedures for prescription dosages that exceed the Food and Drug Administration (FDA) guidelines. If you or your employees notice that a drug has been prescribed an unusually high dosage or in a dosage that exceeds the FDA’s recommendations, you should first check the drug’s dosage guidelines on one of the online references. If the dosage does, in fact, exceed FDA guidelines, you should contact the prescriber to verify the dosage amount. Be sure to get a hard copy of all communication regarding dosage and include the patient’s diagnosis and the prescriber’s reason for overriding the dosage guidelines.
  • Ensure your employees properly document when a beneficiary receives his or her prescription. This is one of the rules that exists to ensure the chain of possession is accurate. When you fill a prescription for someone, you must document that they received their prescription. Maintaining an accurate signature log can help you avoid accusations of fraud.

An Illinois Medicare Pharmacy Audit Defense Lawyer Can Help

Before you are subject to a field audit, CMS will notify you of the date, giving you time to prepare and ensure things are in good working order. A CMS audit can be extremely important -- consequences of a negative audit can range from a simple warning or monetary fine to forfeited CMS reimbursements. At the Law Offices of Joseph J. Bogdan, LLC, we can help you prepare for an upcoming CMS audit or we can help you challenge the results of an already completed audit. Get in touch with our knowledgeable Illinois Medicare pharmacy audit defense attorneys today to begin talking about your case. Call our office at 630-310-1267 to schedule a free consultation.

 

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IL license defense lawyerIf you are a healthcare provider that prescribes controlled substances, you are being monitored by the Drug Enforcement Administration (DEA). Due to the potential for illegal activity in the pharmacy business, DEA inspectors visit pharmacies to ensure that they are complying with all regulatory standards. If the DEA pays a visit to your pharmacy, it is important to react in a calm and professional manner. Still, a DEA investigation can lead to harsh punishments and even license revocation. If you are facing a DEA investigation, contact a license defense attorney that you can believe in.

Preparing for a DEA Visit

Due to the implementation of the Controlled Substances Act, the DEA is allowed to inspect a pharmacy, investigate the receiving and distribution of controlled substances, and even take substance samples. How you react to a DEA visit can make all the difference in ensuring that the investigation goes smoothly.

Be Respectful: When the DEA arrives at your pharmacy, for an inspection, it is easy to feel attacked, and become flustered. As the inspectors arrive, being kind and respectful can set the investigation off on the right foot. All that considered, it is also important to understand your rights. A DEA inspection can only take place with your consent. If the inspection is not being conducted during standard business hours, or there is not proper personnel on site, you can request for the inspection to take place at a different time.

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IL license defense lawyerAudits to your pharmacy can be made by insurance companies, pharmacy benefit managers and third-party payers. Many pharmacy owners view audits as a threat to their business and with good reason.

The outcome of an audit can mean that a pharmacy is required to pay large sums of money that the auditing agency says it is owed. This could be taken out of what would be payments from future money that would be paid to the pharmacy.

Audits should be taken seriously, and often an attorney can safeguard a pharmacy’s rights as well as negotiate issues that may come up in the course of an audit.

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IL licensing attorneyIf you have received notice of an upcoming pharmacy benefit managers (PBM) audit, there are several things you can do to prepare. The consequences of a PBM audit are real and can be long-lasting. Going into an audit prepared is advisable.

Many clients find that adequate preparation can alleviate problems that can come up during an audit. A skilled PBM audit defense attorney can identify specific areas that you should focus on in the time before your pharmacy’s audit. However, typically you will benefit from taking the following steps:

  • Review the written on-site audit notification. You want to pay close attention to the scope of the audit, including the date ranges that the audit will cover. The terms of the audit as stated in the letter should comply with your contract and will applicable laws. An attorney may be needed to determine compliance.
  • Check the date of the proposed audit. This date should be a date when you and other needed personnel will be present. An audit should not be left to employees to handle.
  • Create an audit file. This file or box should contain all correspondence, records, notes, and documentation of telephone calls related to the audit.
  • Meet with your staff. Your staff should be prepared for the audit as well.
  • Organize your records and conduct a self-audit. You should review what records you have as well as identify any problem areas that the PBM auditor may spot.
  • Prepare a designated physical area for the audit. This area should be private. It should also be away from your employees’ spaces and pharmacy operations. Often a closed-off breakroom with a table and chair is suitable.

Contact an Illinois PBM Audit Attorney

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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.

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Illinois pharmacy audit defense attorneyPharmacies undergo both random and routine audits to ensure they are meeting the needs and best interest of consumers. Safety, cost management, and compliance are all issues that are examined during these inspections. Pharmacy audits may also search for any evidence of drug diversion among staff members. Learn how to protect yourself and your pharmacy from consequences of a poorly completed audit with help from the following information.

Advance Preparation for Routine Audits

Routine audits typically occur around the same time each year. Because of this, pharmacists and personnel have time to prepare. It is highly suggested that pharmacies do this with an experienced attorney who can conduct a review of the contracts, policy manuals, agreements, and other documents. An attorney can also review the pharmacy’s day-to-day operations to search for any compliance issues that need to be addressed. Lastly, an attorney can ensure you understand the audit process so that you and your staff know what to expect.

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