PHARMACY ALERT: Be Cautious of OIG Inquiries into Your Pharmacy’s E1 Transaction History

During the Implementation of Medicare Part D, the Centers for Medicare & Medicaid Services (CMS) created a mechanism to allow pharmacies to determine eligibility for Medicare Part D benefits. The process is called an E1 transaction and confirms the Medicare Eligibility of an individual after submission of basic demographic information.

Recently, Frier Levitt has become aware that the Department of Health and Human Services (HHS), Office of Inspector General (OIG) is making inquiries of number pharmacies regarding past utilization of the E1 transaction to determine whether there has been regulatory compliance. 

We believe inquiries by the OIG are focused on review of pharmacies that process large number of E1 transactions to determine whether patients are eligible for diabetic testing supplies under a Medicare Part D benefit. The OIG inquires may also look into pharmacy practices to obtain patients and any marketing companies that are utilized.

Frier Levitt frequently advises pharmacies that are subject to an OIG investigation. Contact Frier Levitt today to learn more about these OIG investigations into E1 transaction history.

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