Pharmacy audits are a common practice in healthcare. These audits include a comprehensive review of a pharmacy’s records, practices, and procedures to determine whether it is in compliance with relevant laws and regulations, as well as to identify any potential areas of risk.
Pharmacy audits can be conducted by government agencies, private insurers, pharmacy benefit managers (PBMs), and third-party auditors. The process itself involves examining the pharmacy’s records, including prescription records, billing records, dispensing records, and inventory records, as well as an inspection of the pharmacy’s facilities and procedures.
If a pharmacy audit identifies potential compliance issues or fraudulent activity, the pharmacy may be subject to sanctions or penalties. These can include fines, revocation of licenses, or exclusion from participating in certain government programs. The following is a brief overview of the areas that auditors may examine. If you have questions about a pharmacy audit, the legal team at Williams & Nickl, LLC can help.
One of the primary purposes of a pharmacy audit is to ensure that the pharmacy is dispensing medications in accordance with federal and state laws and regulations. This includes verifying that the pharmacy is properly licensed, that it is dispensing only FDA-approved drugs, that prescriptions are being filled accurately and in compliance with dosage and quantity limits, and that appropriate documentation is being maintained.
Pharmacy audits also help to prevent and detect fraudulent activity, such as overbilling, upcoding, and other forms of financial abuse. Auditors will review billing records to ensure that claims are being submitted accurately and that the pharmacy is not overcharging for medications or services. Additionally, auditors will review dispensing records to ensure that prescriptions are being filled properly and that there are no instances of prescription fraud or diversion.
Avoiding Issues with a Pharmacy Audit
In order to minimize the risk of allegations of noncompliance and fraud resulting from a pharmacy audit, pharmacies should maintain accurate and detailed records, implement effective compliance policies and procedures, and stay up-to-date with relevant regulations and industry best practices. Since there is rarely advanced notice of a pharmacy audit, all pharmacies should be prepared to respond to an audit by keeping all of their records and documentation organized and readily available.
Contact an Illinois Pharmacy Audit Lawyer for Legal Assistance
Pharmacy audits play a critical role in ensuring the integrity of the healthcare system by detecting and preventing noncompliance and fraudulent activity. By maintaining strong compliance practices and preparing for potential audits, pharmacies can protect their licenses, reputations, and financial well-being.
If you would like to learn more about preparing for future audits, or if your organization has run into issues with a recent audit, call our Chicago, IL pharmacy audit attorneys at Williams & Nickl, LLC at 312-335-9470 to schedule a free and confidential consultation.