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Pharmacy Compliance CVS Caremark Audit Defense Lawyers

July 2, 2020

In modern healthcare, virtually all pharmacies are forced to rely on pharmacy benefit managers (PBM) such as CVS Caremark. An intermediary between the pharmacy and payors, a PBM can be crucial for making sure payments are made in a timely manner and that the billing process is streamlined. However, since a PBM is always subject to strict regulations, pharmacies must always be in compliance with the rules associated with their PBM. If this is not the case, an audit is conducted by investigators which may result in your pharmacy being forced into recoupments, offsetting of future billings, and even the termination of your contract with the PBM, which could mean financial ruin for your pharmacy. If problems have arisen regarding CVS Caremark, turn to pharmacy compliance CVS Caremark audit defense lawyers for advice and guidance.

You’re Not the Only Pharmacy
If your pharmacy is currently under a CVS Caremark audit, don’t think it is the only one in this situation. In fact, since CVS Caremark audits take place 24/7, it is likely many others are experiencing a similar set of problems. As to why these audits take place, most are triggered by complaints lodged against a pharmacy by payors or patients. However, it is not at all uncommon for CVS Caremark to conduct random and routine audits of pharmacies within its network to ensure they are in full compliance with existing rules and regulations.

An Audit Doesn’t Always Mean Trouble
While a CVS Caremark audit will be stressful and inconvenient, it does not necessarily mean your pharmacy will ultimately face severe penalties. If your pharmacy is compliant with existing rules and regulations, it will only be a matter of producing the necessary documentation to show investigators you have done nothing wrong. Unfortunately, almost all pharmacies have made some mistakes along the way, even if they have strict compliance programs in place. Because of this, investigators will spend large amounts of time pouring over documentation to see what if any penalties are necessary. To make sure you get a favorable outcome regarding your CVS Caremark audit, turn to pharmacy compliance CVS Caremark audit defense lawyers who have years of experience handling and winning these cases.

Jumping to Conclusions
When these audits take place, investigators will be looking hard to see if your pharmacy has improperly billed various payors. If you can produce evidence showing this is not the case, you will have little to worry about. However, if you cannot explain certain things or cannot produce documents supporting your argument, investigators will often jump to conclusions and assume you are guilty of wrongdoing. As a result, this can lead the audit and investigation down a perilous path for you and your pharmacy. If investigators make the wrong assumptions, you could find yourself facing a long legal battle to keep your pharmacy in operation. Instead of facing this situation, work closely with pharmacy compliance CVS Caremark audit defense lawyers to win your case and send investigators on their way.

Excluded Providers
As for violations you do not want to find yourself being accused of by CVS Caremark auditors, it is that your pharmacy accepted prescriptions from excluded providers and later billed Medicare, Medicaid, or other federal health programs for reimbursement. Should this occur, expect the Office of the Inspector General from the U.S. Department of Health and Human Services to get involved in the audit. Whether the acceptance of prescriptions from excluded providers was or was not intentional, your pharmacy could be facing stiff financial penalties and the loss of your PBM contract.

Falsifying Records
While most pharmacies do not have problems with records that have been falsified, there are occasions where an employee may be doing so in an attempt to gain illegal compensation from doctors or others. In other instances, an employee may falsify records to steal controlled substances and sell them on their own. Whatever the case may be, this can lead to serious charges that will require compliance and audit defense lawyers who have extensive knowledge and experience planning strategies for these cases.

Should you be facing these or other similar allegations during your CVS Caremark audit, rely on the expert advice of skilled audit defense attorneys.

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