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What Really Starts Pharmacy Investigations?
Manage episode 438702486 series 3506216
Treść dostarczona przez Darshan Kulkarni. Cała zawartość podcastów, w tym odcinki, grafika i opisy podcastów, jest przesyłana i udostępniana bezpośrednio przez Darshan Kulkarni lub jego partnera na platformie podcastów. Jeśli uważasz, że ktoś wykorzystuje Twoje dzieło chronione prawem autorskim bez Twojej zgody, możesz postępować zgodnie z procedurą opisaną tutaj https://pl.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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