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What Really Starts Pharmacy Investigations?
Manage episode 438702486 series 3506216
Contenido proporcionado por Darshan Kulkarni. Todo el contenido del podcast, incluidos episodios, gráficos y descripciones de podcast, lo carga y proporciona directamente Darshan Kulkarni o su socio de plataforma de podcast. Si cree que alguien está utilizando su trabajo protegido por derechos de autor sin su permiso, puede seguir el proceso descrito aquí https://es.player.fm/legal.
We discuss the seven ways pharmacy investigations can begin:
1. Data Analysis: Agencies like the DEA and DOJ monitor prescription data for unusual patterns, such as excessive dispensing of certain drugs.
2. Tips: Anonymous reports from the public or industry insiders alert authorities to suspicious activities.
3. Whistleblowers: Individuals within organizations can confidentially report wrongdoing, potentially leading to legal action under the False Claims Act.
4. Patient Complaints: Concerned patients can file complaints with state boards overseeing pharmacies.
5. Insurance Investigations: Agencies like the Texas Department of Insurance audit pharmacies to ensure billing practices are legitimate.
6. Billing Audits: Contractors such as Racs Maxs UPIC identify billing errors or questionable practices, triggering investigations.
7. Strike Forces: Government agencies collaborate across programs like Medicare and Medicaid to combat fraud through coordinated efforts.
In essence, pharmacy investigations start with someone noticing suspicious behavior. For legal advice regarding your pharmacy, contact me at 302-252-6959.
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