PBMs often conduct invoice reconciliation audits to ensure pharmacies maintain sufficient quantities of medications to support the quantities billed. Recently, a New York-based pharmacy was facing a large recoupment following a PBM invoice reconciliation audit when the PBM alleged the pharmacy did not have proper inventory. Despite the submission of the underlying invoice documentation and even pedigree, the PBM refused to consider the pharmacy’s purchases on the basis of a minor clerical error, subjecting the pharmacy to over $700k in recoupment. With Frier Levitt’s assistance, the pharmacy was able to appeal the audit results and demonstrate the pharmacy had maintained sufficient inventory at all times, reducing the recoupment associated with any alleged inventory shortfalls.
Maintaining proper documentation, including invoices and purchase histories, as well as pedigree documentation, can prove vital in the event of an invoice audit. If your pharmacy is facing a PBM audit, contact Frier Levitt today to speak to an attorney.