Frier Levitt Resolves Over $600,000 of Audit Findings Issued Against California Pharmacy by Major PBM

Frier Levitt successfully resolves over $600,000 of the audit findings issued against a California-based pharmacy by a major PBM. Despite the pharmacy’s timely compliance with the PBM’s audit request, the PBM sought recoupment of claims worth more than $650,000 against the pharmacy. To that end, many of the discrepancies alleged did not relate to the improper provision of services to the PBM’s members. Instead, the PBM sought to recover the amounts already remitted to the pharmacy based on the insufficiency of the documents provided by the pharmacy, despite the fact that the pharmacy provided all documents related to the claims and dates of fill at issue in the PBM’s own audit request.

However, with the help of Frier Levitt attorneys, the pharmacy was able to gather the additional documents requested by the PBM and emphasize its compliance with the original scope of the audit, thereby successfully reversing discrepancies worth over $600,000 as of date. Though the pharmacy continues to be engaged in efforts to further resolve the outstanding discrepancies, the resolution of the pharmacy’s initial audit findings demonstrates the importance of appealing any and all discrepancies alleged by a PBM.

PBMs often use “significant” audit findings as a justification to take further disciplinary action against pharmacies, including termination from its provider network. Pharmacies should be sure to appeal all discrepancies identified by a PBM audit to limit potential threats to their network participation, this cannot be overstated.

How Frier Levitt Can Help

If your pharmacy has recently received an audit request or has received findings related to a previous audit, Frier Levitt can help ensure that the documents you submit to your PBM are responsive to their request or help to reverse the alleged discrepancies. Contact us today to speak to an attorney.