California’s 5,000-plus community-based pharmacies dispense billions of dollars worth of prescription drugs each year, so it is important to know that these drugs are being dispensed for legitimate health-care needs. Audits of pharmacy records help determine whether fraud is occurring.
Unfortunately, pharmacy audits have become less about uncovering and punishing fraud and more about making money for pharmacy benefit managers who are hired by health insurance plans to administer prescription drug benefits and perform pharmacy audits.
Too often, the benefit managers penalize community pharmacies by denying legitimate claims. Among the reasons auditors deny claims: minor clerical errors and omissions.