killingbill

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i'm a pharmacist working for a big chain in nyc. i was told by my DM that anyone who has medicaid/medicare and is a waiter we have to bill a flu shot WITHOUT asking the customer if they want it and ask them if they want the shot after billing it just so they don't have to wait for us to bill a shot. is this medicaid/medicare fraud? i was also told that i have to get my flu shot numbers up or i would be replaced. can they do this??
 

npage148

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It's only gonna be fraud if you don't reverse the claim if they don't want it
 

Allure

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That is so stupid. If they have already received the flu shot, I am going to assume that medicaid/medicare would reject the claim. It takes a lot more time doing that vs. just asking them if they've received one and would want one. If they're claiming that they don't want those customers to wait, then just ask them while they're at drop off. It's not like they have to wait any longer. This sounds like the doing of Walgreens.
 

Pharmguy07

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This sounds like the doing of Walgreens.
My first thought as well. Walgreens is obsessed with forcing these flu shots on people. Certainly not a corporate policy, but a lot of DM's are coming up with stupid crap to push flu shots.
 

Momus

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Tell them by pushing flushots, it will drive the revenue down since it will make people protected from the flu, thus a potential a loss of revenue from cough and cold OTC sales, front end sales and the bandwagon Z-pack sales LOL >_>!
 

Vitamin K

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Tell them by pushing flushots, it will drive the revenue down since it will make people protected from the flu, thus a potential a loss of revenue from cough and cold OTC sales, front end sales and the bandwagon Z-pack sales LOL >_>!
Way to be a patient advocate...
 
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wags makes 10 bucks profit on each flu shot

so of course they are gonna push it down your throats
 
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You can't bill the government until service has been rendered so it is fraud. File a complaint before you are caught up in this whole mess.
 

npage148

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You can't bill the government until service has been rendered so it is fraud. File a complaint before you are caught up in this whole mess.
So how are you able to fill a script (new or refill) when the person is planning on picking it up in a week? I want to say, but not positive, you are not billing until the person is rung out.
 

MountainPharmD

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You can't bill the government until service has been rendered so it is fraud. File a complaint before you are caught up in this whole mess.
It is not fraud. As a previopus poster said we bill prescriptions all the time before the patient picks them up. It becomes fraud if we do not reverse the claim on a scipt that a patient never picks up. Same thing with a flu shot. It is fraud if the patient tells you they do not want a flu shot and you do not reverse the claim.
 

charfdorn

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i'm a pharmacist working for a big chain in nyc. i was told by my DM that anyone who has medicaid/medicare and is a waiter we have to bill a flu shot WITHOUT asking the customer if they want it and ask them if they want the shot after billing it just so they don't have to wait for us to bill a shot. is this medicaid/medicare fraud? i was also told that i have to get my flu shot numbers up or i would be replaced. can they do this??
Yes, they can absolutely replace you for not doing X or Y, especially if they told you to do it. That only applies to getting your numbers up.

I don't think it's fraud to do this particular tactic, but I wonder if it might be a HIPAA violation to attempt to bill for a service you hadn't spoken to the patient about. I mean, if I went into my doctor's office and they said, "hey, you know your insurance will pay for these tests, can we go ahead and do them?" I would find a new doctor.
 

owlegrad

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Yes, they can absolutely replace you for not doing X or Y, especially if they told you to do it. That only applies to getting your numbers up.

I don't think it's fraud to do this particular tactic, but I wonder if it might be a HIPAA violation to attempt to bill for a service you hadn't spoken to the patient about. I mean, if I went into my doctor's office and they said, "hey, you know your insurance will pay for these tests, can we go ahead and do them?" I would find a new doctor.
How on earth is this a HIPAA violation? I don't think it is a good practise, but how is HIPAA involved in this?
 

charfdorn

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How on earth is this a HIPAA violation? I don't think it is a good practise, but how is HIPAA involved in this?
Randomly polling someone's insurance to see what it will pay? I don't know, I'm grasping at straws for legal grounds to end this despicable practice.
 

owlegrad

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Randomly polling someone's insurance to see what it will pay? I don't know, I'm grasping at straws for legal grounds to end this despicable practice.
:laugh: Fair enough.