A recent report from the Office of the Inspector General indicates that roughly a quarter of pharmacies that produce topical pain relief creams in-house may receive increased scrutiny due to some “red flags” that suggest these locations are defrauding customers. While the report has yet to lead to legal charges, many of the pharmacies in question operate in and around New York City, so these locations certainly have cause for concern.

The report indicates that the pharmacies in question all used practices or generated certain figures that gave cause for concern in Medicaid officials, who saw potential evidence of fraud in a number of locations. These officials looked at five different categories of potential abuse, with over 500 pharmacies allegedly using at least one method and 10 allegedly using all five methods.

For pharmacists and pharmacy managers who have concerns about the legal standing of their business practices, now is not the time to panic, nor is it the time to bury one’s head in the sand and assume everything will be fine. Instead, it is wise for anyone who has concerns over their pharmacies’ practice and potential charges that could arise to build a strong legal defense, and the sooner the better.

“Red Flag” practices

The report indicated that the pharmacies under further scrutiny for potential fraud all allegedly took part in at least one of five troubling practices. These include

  • “Extremely high” pricing, which may indicate localized price gouging
  • Numerous Medicare recipients receiving identical drugs and drug orders
  • Abnormally high percentage of customers making Medicare claims
  • Significantly increased year-over-year billing to customers
  • Single Medical care providers writing a high volume of prescriptions

While there are potentially legitimate explanations for each of these concerning practices, no business is interested in increased scrutiny from a government agency, and even if a pharmacy does use one or more of these practices, that does not mean that it rises to the threshold of fraud.

Protecting your future in the pharmaceutical industry

If you suspect that you may face some additional scrutiny from regulatory agencies, make sure that you have a strong legal strategy in place as soon as possible. No matter what you or your pharmacy may or may not have done in the past, the worst thing that you can do about it now is failing to prepare for the worst. Use all the legal tools you have to keep your rights secure and your business protected while you sort through working in today’s complex medical field.