Medicare is Targeting Pharmacies

In 2012, more than 2,600 U.S. drug stores, or about 4 percent of all retail pharmacies are being investigated for suspicious or excessive billing to Medicare.

Medicare is now using quantitative analysis to identify so-called “suspicious billing”. This means that the government is using statistical analysis to determine where to start investing for fraud. Some pharmacies dispense unusually high percentages of painkillers and other controlled substances or expensive brand-name drugs. There are also claims that some stores billed Medicare a per patient rate of more than 2.5 times the national average. The 2,637 suspect pharmacies billed Medicare about $6 billion. Most of the stores under investigation are independent pharmacies not chain pharmacies.

These pharmacies may be unfairly targeted because independent pharmacies serve a higher proportion of nursing home residents and other patients with serious medical conditions than Chain pharmacies. Many times, these patients need more drugs than average Medicare beneficiaries.

Khouri Law Firm has extensive experience representing pharmacies in billing investigations by Medicare, Medicaid, private insurance, and workman’s compensation. Khouri Law has represented both Home Infusion and Compounding Pharmacies being investigated for inventories and purchases versus billed amounts to Medicare. Through extensive investigation himself, Mike Khouri has been able to sue federal regulators for manipulating inventory numbers to the detriment of the independent pharmacist.

If you find yourself the target of an investigation by any insurance company or government agency, call Khouri Law Firm before supplying any information. You will be able to find out what your options are and what to do next. You will be glad you did.