How To Set Up A Pharmacy Compliance Program

Tuesday, November 8th, 2016

Over the years, many pharmacies and pharmacists have been charged with or convicted of Medicare fraud, or for fraud committed on another government program. The truth is that a pharmacy employee can commit fraud too. You may not permit the illegal practice, but if you do not have effective internal controls and compliance programs, then your intent is not enough.

Law enforcement agencies all across the country are investigating pharmacies for fraudulent overcharges and kickback schemes. This has put pressure on the industry as a whole as everyone scrambles to avoid these investigations. While you are not expected to personally monitor each transaction, you should set up a pharmacy compliance program designed to encourage lawful behavior. The following tips will help you learn how to start your compliance program the right way.

Basics of a pharmacy compliance program

A pharmacy compliance program has two purposes. First, the program should prevent your employees from breaking the law. Your program should include internal rules, enforcement mechanisms, and trainings to ensure that your employees act lawfully. Second, this type of plan works to shield you and your pharmacy from criminal prosecution. If fraud does occur, an effective compliance program is strong evidence that you did not condone it and would have stopped it if you were aware.

In order for a criminal prosecution to succeed, the prosecutor must establish that you intended to circumvent the law. If investigators find that you have a pharmacy compliance program and that your company adheres to it, then that shows you did not intend to commit a crime. Essentially, compliance programs limit the damage of these investigations and help your company avoid a criminal prosecution. However, you must faithfully enforce the policies and standards stated in the compliance program. It is not enough to have a written policy, so there must be evidence that the program is enforced.

Elements of a pharmacy compliance program

Every pharmacy compliance program should consist of three basic elements, which are policy, training, and enforcement. The policy should be written down and distributed to your entire company. You can also include your pharmacy compliance program in your company bylaws and other corporate documents to emphasize their importance. The policy should be posted in employee areas, included in the employee handbook, and sent as reminders in emails.

Training sessions should be thorough and regular. Consider appointing compliance officers that are responsible for preparing and presenting these training seminars. Topics on things like fraud, kickback laws, HIPAA, OSHA, and the Stark Law are good areas to cover. These training sessions should be held regularly so new employees can learn and old employees can brush up.

If you have questions regarding the implementation of a pharmacy compliance program, contact the Healthcare Team at Brown & Fortunato for more information. Give us a call at (806) 345-6300 or Contact Us via email today. We invite you to visit our office at 905 S. Fillmore St., Suite 400, in Amarillo, Texas for an in-person consultation and to learn more about our practice areas.

This information is subject to change. Please check for updates that are more recent than the published date of this article.