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PCMA: Anti-Fraud Report Highlights Concerns About ACA Implementation

HealthLeaders Media Staff, October 22, 2010

The PCMA praised the study, noting that some policies meant to help independent pharmacies inadvertently open the door to fraud, abuse, and wasteful spending. PCMA President and CEO Mark Merritt tells HealthLeaders the report "will outrage the independent drugstore lobby’s allies on Capitol Hill who had no idea that their agenda facilitated pharmacy fraud and abuse."

PCMA outlined three areas that merit particular attention. According to the organization:

  • "Any willing pharmacy" policies would force plans to include in their networks pharmacies that have been banned from federal programs.
  • "Audit Reform" policies, which undermine payers’ ability to audit independent pharmacies suspected of fraud.
  • "Prompt Pay" policies which, according to the PCMA, reduce payers’ time to verify pharmacy claims before payment. On this point, PCMA cites the NHCAA white paper: "[I]f claims are not rushed through the payment process, auditors and investigators will have more opportunities to detect attempts at fraud before they come to fruition."
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