Pharmacy Alert: PBM Demands Return of Overpayment For Claims Submitted under LINET Program

A national Pharmacy Benefit Manager (PBM) has recently issued a letter demanding return of overpayments to a number of independent pharmacies for claims submitted under Medicare’s Limited Income Newly Eligible Transition Program (LINET Program).  The PBM alleges that the pharmacies overbilled the prescription claims, which were submitted at least 5 years ago, above the LINET Program’s pricing thresholds.   More troubling, the PBM suggests that the claims have been referred to the Office of Inspect General (OIG) for further review. 

Pharmacies should review the claims alleged as overbilled and provide a robust response to the PBM.  Otherwise, the pharmacies could be subject to sanctions beyond the monetary penalty.  In the same vein, the OIG may conduct an investigation against the Pharmacy based on the claims referred by the PBM. 

How Frier Levitt Can Help

Time is of the essence, if your pharmacy received such a demand letter, contact us today to speak to an attorney.  Frier Levitt’s attorneys have the knowledge and expertise to help your pharmacy reconcile allegations of overpayment.

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