BNA, December 15, 2011

The Centers for Medicare & Medicaid Services has instructed all Medicare Part D and Medicare Advantage prescription drug plans that they can withhold pharmacy payments for suspicious claims as part of an effort to reduce fraud and abuse within the program, according to a memorandum released Dec. 13. Complying with prompt payment requirements does not preclude prescription drug plans from establishing drug utilization management and quality assurance measures to ensure that claims are accurate prior to payment, the memorandum said. Plans can withhold payment until an investigation has determined that the claim is not fraudulent, the memorandum said.  v
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