Panicked!!! Failed audit today

[legrita]

Hi,
I am a PIC at CVS. US Script, which is like the PBM for a segment of medicaid in our state, came in today for a scheduled audit and I am told we failed. I was unable to make it to the audit since it was my one day off in weeks and I needed to tend to my kids school related activities. I had a respresentative there and I had pulled all the hard copy bundles for the 13 months they were auditing. Apparently, we were missing 30 out of 150 scripts and we did not have the federal "Know Your Rights" statement that is required to be posted for the customers to read. I am still receiveing intel from my team members, so I don't know all the details yet. I go in to work tomorrow. I've never been thru this kind of audit before, so this is extremely unerving for me. I tried to call my boss to give her the heads up, but she was out of touch.

1. What will happen to me?
2. Has anyone been thru this before?
3. What "know your rights" statement?
4. Will I be placed on the exclusion list for the OIG?

As you can tell....I am REALLY freaked out!!!

Thanks in advance for your response.

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[Digsbe]

I haven't much experience with this, but from what I've noticed they usually fine the pharmacy and refuse to pay for the scripts that they deemed were improperly billed.

I would assume that the "know your rights" info is the HIPAA and pharmacy privacy policy papers that must be offered to all new patients. As far as exclusion goes, I am unsure as to how they will handle it.

 

[legrita]

Thank for replying. I have the HIPAA and Privacy statements clearly displayed and they said it was not what they were looking for...sigh

 

[BMBiology]

I hate to say this but you don't know what "know your rights" is and took the PIC position?

 

[BidingMyTime]

I hate to say this but you don't know what "know your rights" is and took the PIC position?

I'm not surprised, generally people with the most experience are the ones wary of taking on a PIC job....its the inexperienced who have no idea what they are getting themselves into that take on the PIC job.

To the op....some general advice, since the exact regulations are going to differ by state. Most likely there is an "appeal" process, if you can find the missing scripts (hopefully they are just misfiled somewhere?) then you can submit them to the PBM--the pharmacy may still get fined by not having them "readily" available, but its still better to find them late, than not at all. If you are missing the scripts, and they are genuine scripts, then the doctor's office will still have records of it--you need to find out what the PBM would want you to get from the doctor to verify the script was legitimate and not fraudulent. I'm surprised that the "know your rights" wouldn't be part of the CVS required signage...surely you have it hanging up somewhere, you just aren't recognizing what it is. I would think a probation would be more likely than an out and out exclusion, based on what you've described. The important thing is to fix the deficits immediately, that can be put into the appeal, that you fixed the problem when it was brought to your attention--if you are missing the required sign, get it hung up immediately, if you are missing 30 scripts, then devise a better plan for organizing/storing scripts to help prevent them from being lost in the future.

I would imagine your supervisor will get back to you as soon as possible and guide you through the steps of what to do next (I'm a bit surprised that your supervisor would haven't arranged to be in your store during such an important audit, especially knowing that you weren't able to be there

 

[legrita]

I'm not surprised, generally people with the most experience are the ones wary of taking on a PIC job....its the inexperienced who have no idea what they are getting themselves into that take on the PIC job.

To the op....some general advice, since the exact regulations are going to differ by state. Most likely there is an "appeal" process, if you can find the missing scripts (hopefully they are just misfiled somewhere?) then you can submit them to the PBM--the pharmacy may still get fined by not having them "readily" available, but its still better to find them late, than not at all. If you are missing the scripts, and they are genuine scripts, then the doctor's office will still have records of it--you need to find out what the PBM would want you to get from the doctor to verify the script was legitimate and not fraudulent. I'm surprised that the "know your rights" wouldn't be part of the CVS required signage...surely you have it hanging up somewhere, you just aren't recognizing what it is. I would think a probation would be more likely than an out and out exclusion, based on what you've described. The important thing is to fix the deficits immediately, that can be put into the appeal, that you fixed the problem when it was brought to your attention--if you are missing the required sign, get it hung up immediately, if you are missing 30 scripts, then devise a better plan for organizing/storing scripts to help prevent them from being lost in the future.

I would imagine your supervisor will get back to you as soon as possible and guide you through the steps of what to do next (I'm a bit surprised that your supervisor would haven't arranged to be in your store during such an important audit, especially knowing that you weren't able to be there

Thank you. This is very helpful. Will get finding those scripts first thing tomorrow.

 

[owlegrad]

It probably is not as big a deal as you think. Just find out what the required signage is and get it hung up. Try to find the missing scripts. I highly doubt any CVS anywhere would be able to find every script that is asked for in an audit. At least my store never is and no one makes it out to be that big of a deal.

 

[Hello2000]

Maybe you should have switched your days off and should have been there as PIC on the day of the audit?????

 

[legrita]

Maybe you should have switched your days off and should have been there as PIC on the day of the audit?????

My son was graduating today...

 

[wucool33]

My son was graduating today...

My parents didn't come to my graduation... Just saying lol

 

[npage148]

How much time was it scheduled out? I would have called my PDM for assistance or at least to find out what was required

 

[Aznfarmerboi]

Hi,
I am a PIC at CVS. US Script, which is like the PBM for a segment of medicaid in our state, came in today for a scheduled audit and I am told we failed. I was unable to make it to the audit since it was my one day off in weeks and I needed to tend to my kids school related activities. I had a respresentative there and I had pulled all the hard copy bundles for the 13 months they were auditing. Apparently, we were missing 30 out of 150 scripts and we did not have the federal "Know Your Rights" statement that is required to be posted for the customers to read. I am still receiveing intel from my team members, so I don't know all the details yet. I go in to work tomorrow. I've never been thru this kind of audit before, so this is extremely unerving for me. I tried to call my boss to give her the heads up, but she was out of touch.

1. What will happen to me?
2. Has anyone been thru this before?
3. What "know your rights" statement?
4. Will I be placed on the exclusion list for the OIG?

As you can tell....I am REALLY freaked out!!!

Thanks in advance for your response.

1. Nothing will happen to you.
2. Yes
3. Google.com
4. No.

Dont worry about it. Life goes on. Your supervisor might bug you to find those scripts to minimize the loss, or follow the appeal process. Next time, let your supervisor know in advance of the audit so he can send help.

An auditor is there to get money back for the insurance companies (to justify that he is doing his job). If the worst offense they can find is that you are missing "know your rights", I say you are doing fine. You should be worried that they cannot find 20 percent of targeted scripts. Why were they missing? Were they QR scripts and thrown out by mistake? Find a pattern.

 

[BMBiology]

The auditor sometimes use the threat about informing the bop so you would give in...just keep that in mind.

Missing that many scripts is a big no-no

 

[clachan3]

Medicaid and Medicare audits are happening all the time now. It's kind of scary. I'm surprised that CVS didn't provide you the signing you need. May be your supervisor need to call corporate for legal compliance assistance. Missing scripts is horrible, but sometimes even if you have the scripts, they'll still find something wrong with every script. I think these audits are worse than being inspected by the board

 

[clachan3]

Maybe you should have switched your days off and should have been there as PIC on the day of the audit?????

Funny, too bad there isn't such thing as being off as a PIC ahhhh the perks of being the PIC. Do the perks really exist, remind me why we want to be PICs again, anyways...

 

[Hello2000]

Funny, too bad there isn't such thing as being off as a PIC ahhhh the perks of being the PIC. Do the perks really exist, remind me why we want to be PICs again, anyways...

I really just meant that the pic could have heard direct from the horses mouth and may have been able to rectify or shed light as to why there were failures there and then while the auditors were still there?

 

[legrita]

1. Nothing will happen to you.
2. Yes
3. Google.com
4. No.

Dont worry about it. Life goes on. Your supervisor might bug you to find those scripts to minimize the loss, or follow the appeal process. Next time, let your supervisor know in advance of the audit so he can send help.

An auditor is there to get money back for the insurance companies (to justify that he is doing his job). If the worst offense they can find is that you are missing "know your rights", I say you are doing fine. You should be worried that they cannot find 20 percent of targeted scripts. Why were they missing? Were they QR scripts and thrown out by mistake? Find a pattern.

Thank you !! Extremely helpful. I googled the statement via image immediately while the lead tech was on the phone requesting it....I only found a pdf for New York. Thru regular search, I was able to find booklets, not a statement per say. I will keep looking.

Thanks again! Will keep you all posted.

 

[farmadiazepine]

I don't know why anyone wants to be a PIC unless its your own privately owned store. PIC positions at CVS and Walgreens is for suckers, no offense. You can make a ton more money not being a PIC and having a much more relaxing life.

 

[PharmdA07]

Thank you !! Extremely helpful. I googled the statement via image immediately while the lead tech was on the phone requesting it....I only found a pdf for New York. Thru regular search, I was able to find booklets, not a statement per say. I will keep looking.

Thanks again! Will keep you all posted.

Hello. Sorry to hear about the audit. I am actually in Texas and here I don't really know of any "Know your rights" signs per see for MEdicaid; we are required to have the "Consumer Information" sign up with basically says that pt has a right to accept or refuse generics meds. I've googled this "know your rights" for texas but came up with nothing. ANybody please enlighten me with knowledge.
As far as your issues found out by the auditor: the huge thing is missing scripts! I staffed at an independent pharmacy that got audited by medicaid (independents tend to be hit hard by all these regulation madness) and the auditor literally came and stayed in the pharmacy for 1 week to look at records and claims on the computer system. It was crazy then; and s/he found some of the most ridiculous issues such as "brand medically necessary" approved by MD's designee and not MD himself or Triamcinolone prescribed as 70 gram and an an 80 gram tube was dispensed without calling MD; or 1 bottle of pataday claimed for 25-days-supply insted of 30-days-supply. THe point is it's their job to find mistakes, whatever they are or however small and stupid they are, so the state can keep these auditors around on pay-roll ! So as long as you fix all the deficits they told you and send in all necessary paperwork, you're OK. During that audit, all rx requested were found so we were OK. Missing rx can be misconstrued as false claiming to get payment and that can be serious; that's why you need to find all those missing rx's and show them.

 

[chasedo]

P4 student here just wanted to add that I believe the "Know your rights" signage you are referring to is probably the "You have the right to be counseled by the pharmacist about your prescriptions/medications" etc. I know we have one up at Rite Aid where I interned and also at Walmart where I am on my first APPE rotation. I assume it's a state law and your state probably has a similar one.

 

[thephoenician88]

I don't know why anyone wants to be a PIC unless its your own privately owned store. PIC positions at CVS and Walgreens is for suckers, no offense. You can make a ton more money not being a PIC and having a much more relaxing life.

how do you plan on moving up the corporate food chain if you never do anything besides "staff?"

 

[npage148]

Why would you assume someone wants to play the game of corperate ladder climbing?

 

[legrita]

Thanks guys! Found the hard copies....they were Schedule 2 narcotics stored separately from all the others...Still working on the signage....

 

[owlegrad]

Thanks guys! Found the hard copies....they were Schedule 2 narcotics stored separately from all the others...Still working on the signage....

The people in the store at the time of the audit didn't know that?! That's terrible.

 

[legrita]

The people in the store at the time of the audit didn't know that?! That's terrible.

they figured it ou at the latter part of the audit and we ended up passing....with minor deficiencies which I'll follow-up on...

 

[Lnsean]

how do you plan on moving up the corporate food chain if you never do anything besides "staff?"

That's so 1990s. The kool thing to do these days is to start your own tech company or own a business. climbing the ladder is a loser's game.

 

[rxlea]

That's so 1990s. The kool thing to do these days is to start your own tech company or own a business. climbing the ladder is a loser's game.

Unicorns don't have to climb ladders

 

[joetrisman]

Unicorns don't have to climb ladders

Just fly instead

 

[thephoenician88]

That's so 1990s. The kool thing to do these days is to start your own tech company or own a business. climbing the ladder is a loser's game.

i can't tell if this is serious. I'd love to own a business though.

 

[farmadiazepine]

how do you plan on moving up the corporate food chain if you never do anything besides "staff?"

i hope thats a joke question. move up the corporate food chain? lmao, i wouldn't ever do it, i don't really understand why other people do other than they think they can make way more money and have more freedom being more of a boss. you can easily make 200k by only being staff and not having to worry about anything else and being your own boss.