Your pharmacy has an affirmative legal obligation to ensure that it does not associate with (i.e., employ, transact business with, fill prescriptions for, etc.) an individual or entity that is currently excluded from participation in Medicare, Medicaid and all Federal health care programs. Many pharmacies are unaware of this legal obligation. Many pharmacies do not take the necessary steps to ensure that they have fulfilled this obligation. The results of inaction can be severe and may result in your pharmacy having to disgorge revenues received for any items or services furnished, ordered, or prescribed by an excluded individual or entity.
Under federal law, no payment will be made by any federal health care program for any items or services furnished, ordered, or prescribed by an excluded individual or entity. Federal health care programs include Medicare, Medicaid, and all other plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan). If payment has already been issued and your pharmacy is subsequently investigated, you will be required to return any monies you received as a result of your association with an excluded entity.
For example, if a pharmacist that you employ is an excluded provider, your pharmacy will be legally obligated to return any monies it has received from any federal health program for prescriptions filled by that pharmacist. Similarly, if your pharmacy fills a prescription for a physician that is an excluded person, you are legally obligated to return any monies you received in connection with filling prescriptions issued by that physician.
The Office of Inspector General (OIG) maintains a List of Excluded Individuals/Entities (LEIE) database that all pharmacies should periodically check to ensure that they are not associating with an excluded person or entity.
Frier Levitt can assist your pharmacy in its efforts to ensure that it is not associating with an excluded person. Contact us today for assistance.
