Because Medicare processes over one billion fee-for-service claims annually, it is impossible for CMS and its contractors to review every claim – or even a substantial percentage of claims – on a pre-payment basis. Accordingly, Medicare has set up various post-payment mechanisms to investigate and recover those payments that it determines, on a post-payment basis, […]
On December 6, the Department of Justice announced that a federal court ordered Elk Pharmacy Inc., a pharmacy in Elkin, North Carolina, to pay a $500,000 penalty and comply with an injunction to prevent the unlawful dispensing of controlled substances. The injunction prohibits the pharmacy and its pharmacists from filling prescriptions, including for opioids, without […]
As most healthcare providers know, Medicare, like most payors, operates on a “pay and chase” system; meaning, they pay the vast majority of claims promptly, and then audit and attempt to recoup overpayments later should they discover information that calls the propriety of the claim into question. When Medicare attempts to recoup an alleged overpayment, […]
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