Pharmacy audits are complex and burdensome experiences for any pharmacy owner. Due to the serious implications for small and independent pharmacies, it is important to retain competent and experienced legal counsel upon the notice of the audit rather than after you’ve received the auditor’s report to minimize the damage and protect your legal rights.
In the process, a pharmacy will typically receive notice of an audit by phone or mail from a Pharmacy Benefit Manager (“PBM”) notifying the owner that an audit and compliance contractor will be visiting the pharmacy to perform an audit. The auditors are hired by PBMs such as Express Scripts and CVS Caremark, in addition to Medicare Part-D and Medicaid.
While pharmacy audits may appear harmless, they often carry steep financial consequences and the potential for criminal action in the event of fraud or submission of false claims.