Did you know...
Part D auditors from both PBMs and Medicare Part D plans have the ability to pull all your Medicare Part C and Part D reimbursements if you aren’t in compliance … that could be 40 - 50% of your prescriptions each year! Since 2006, CMS Medicare Part D has required each pharmacy to have an active Fraud, Waste & Abuse Prevention Program. As of September 1, 2013, every pharmacy must check their employees and business associates monthly against the OIG, GSA, and SAM Exclusion lists. If you’re not properly documenting your staff’s FWA training and doing monthly exclusion verification checks, your pharmacy is at serious risk.
R.J. Hedges and Associates has provided our business with the tools and support we require to compete in today’s marketplace. They have also set us apart from the competition due to the policies and procedures their team has put together for us. Not only have their sound policies helped us to remain compliant, they have made our organization look inward to see where we have lacked in the past and forced us to make the changes needed to be better health care providers and business people. Their extensive knowledge in human resources, performance management, and ethics has helped our business provide better care to our patients, respect the needs of our employees, and expand our business.
Common Fraud, Waste & Abuse Questions
CMS and Medicare part D plans.
Completing your monthly OIG reports is a mandatory requirement for Medicare part D. If you don’t do your monthly reports a CMS inspector or Medicare part D auditor has the authority to pull back 100% of the Part D reimbursements since the last OIG report was conducted.
Additionally, it is very important that you print out your reports each month for your records so that you can prove that you have completed the monthly requirement.
Some of the main reasons people are listed on the OIG Exclusion list are: conviction of a health care related felony, insurance or Medicare fraud, health care students defaulting on student loans, State Board revoking license for disciplinary actions, and failure to allow an inspector in your facility.
- OIG (Office of Inspector General) - Healthcare related incidents and exclusions
- SAM (Security Accounts Manager) - Government contractors who default on their contract with the government
- GSA (General Service Administration) - Award contracts of supplies and services to the US government, if you fail to meet the requirements of the contract or default on the contract the company and/or individual is listed on the exclusion list.