PBM Audits Defense Attorneys
Pharmacy Benefit Manager, or PBM audits, are the audits that pharmacies often face. Any pharmacy facing an audit needs an experienced defense attorney or law firm on its side, and that’s just what the Norman Spencer Law Group can offer. Our firm defended cases on behalf of pharmacies, state and national pharmacy associations, and also physician dispensers.
We saved our clients millions of dollars in the PBM audits before all of the major PBM companies. We’ve also handled many different legal issues before all the big three (CVS Caremark, Express Scripts, and OptumRx). We handle both the pre-litigation dispute resolution process as well as arbitration and litigation. We’ve seen firsthand just how dangerous a PBM audit can be to you and your pharmacy.
What Pharmacies Face During an Audit
PBMs will quite routinely conduct their audits. While conducting the audits, PBMs monitor the pharmacy’s performance and identify any improper payments. PBMs will often go beyond the original intent of the audit and use the process as a sort of source of revenue for themselves. Of course, at the expense of independent pharmacies, plan sponsors, taxpayers, and most importantly, the patients themselves. PBMs can even take the entire amount of the reimbursement of any medication that the pharmacies had already dispensed.
This not only causes pharmacies financial harm but also disrupts the pharmacy’s day-to-day business. PBMs hire third-party companies – such as SCIO, Xerox, Conduent, amongst others, in order to conduct pharmacy audits. Very often, these companies receive compensation based on the total amount of money they recoup on behalf of that PBM. There is no surprise in that they are incentivized to find as many discrepancies as possible.
About PBM Audits
When conducting an invoice audit, a PBM will generally examine limited types of claims a pharmacy submitted in a certain timeframe. For instance, in an invoice audit, a PBM is going to be looking to match the purchase history of the pharmacy with the number of claims that were the pharmacy submitted. Auditors will request the pharmacy to provide this through the wholesalers’ invoices and purchase summaries. Despite the relatively uncomplicated nature of an invoice audit in general, various PBMs use different strategies in order to discredit certain valid purchases pharmacies made. In response, the pharmacies will have to prove that these otherwise harmless purchases were in fact just that.
What Kind of Help is Needed?
When you’re facing a PBM audit, you’ll need the very best lawyers by your side. Along with this, you’ll need counsel that has experience with pharmacy law and PBM audits. Most attorneys have no idea how to handle these cases.
How Norman Spencer Can Help With PBM Audits
It’s easy to feel alone when you’re facing a PBM audit. When you add to that the incredible stress that accompanies legal trouble, you need a firm of experienced defense attorneys that can empathize, understand, and fight for you in court.
At the Norman Spencer Law Group, our focus is on making the entire process as smooth and easy as it can be for our clients. This starts with our focus on 1:1 service and 24/7 availability. On top of this, we have accessible options like legal consultations that are hosted remotely via Zoom, Skype, or Google Duo. And even if you’re in another part of the country, we’ll send someone out to you if need be.
Our excellent client service is just the beginning of the process. Our defense lawyers have years of experience handling cases just like yours, and there’s no case too simple or complex, too large or small for us. We have a proven track record so when you choose the Norman Spencer Law Group, you’re choosing the best possible firm to represent your case, but more importantly, you’re choosing the best possible firm to represent you. So get in touch, let us know who you are and what kind of legal problems you’re facing, give us your contact information, and a member of our team will be in touch as soon as possible to get you the help that you need.