Frier Levitt recently helped a Texas-based independent pharmacy that was facing an audit conducted by a national PBM. The PBM alleged various discrepancies including drug invoice shortages. The discrepancies amounted to significant audit fines. Despite the submission of the underlying invoice documentation, the PBM continued to allege the drug invoice shortage discrepancies. With Frier Levitt’s assistance, the Pharmacy was able to appeal the audit discrepancies and demonstrate that the Pharmacy did in fact maintain sufficient inventory at all times. Ultimately, the PBM reduced the discrepant amount by 95%.
Contesting PBM audit discrepancies will not only reduce a pharmacy’s financial liability but also mitigate the risk of additional sanctions, such as PBM network termination, that can be imposed by PBMs. It is no secret that PBMs keep track of their network pharmacies’ audit histories and use prior audit results as justification to terminate the pharmacy years later after the pharmacy has another adverse audit finding. In other words, regardless of the amount of audit discrepancies, pharmacies should emphatically contest PBM audit discrepancies.
How Frier Levitt Can Help
Regardless of the size of your pharmacy or the amount at stake, Frier Levitt is ready to assist you in successfully challenging the audit. Our attorneys include clinicians who are prepared to take an aggressive approach to fight for your rights following a PBM audit. If you have questions or need help with a PBM audit, contact us today to speak to an attorney.
