Medicare, Medicaid & Third Party Audits/Compliance Programs: A Changing Landscape

Pharmacies are facing a growing number of audits. Payors are often employing a variety of techniques, including invoice audits, desk audits, regulatory audits, and mining protocols. Here, Wilentz’s Angelo Cifaldi and Satish Poondi discuss the impact of audit results, including the recoupment of millions of dollars and the potential impact on the licensure of the pharmacy. Additionally, they address the importance of pharmacies' understanding the anatomy of an audit, their legal rights, and how to minimize potential liability. Case studies in the field are also discussed. 

Learning Objectives: 

I.     Define the terms Fraud, Waste, and Abuse 

II.    Describe common audit techniques 

III.   Understand key components of compliance programs 

IV.   Discuss common legal issues that arise in responding to an audit