OIG settles pharmacy cases from invoice initiative

The OIG’s Provider Field Investigations unit continues to pursue cases resulting from a pharmacy invoice initiative. The initiative is a data-driven proactive approach which detects pharmacies with unusual billing patterns. During the first quarter of this fiscal year, seven full-scale investigations involving pharmacy invoices were completed and referred to OIG Litigation for further action.

The OIG executed a settlement agreement in October with a pharmacy in Pharr for unsupported billed services and a lack of appropriate authorization from the prescribing physician during June 2015 through May 2019. Through a collaborative effort, the provider agreed to repay $80,000 as settlement. A pharmacy in Temple reached a settlement with the OIG in August. The quantity of particular pharmaceuticals that were billed did not correspond to the amount that was ordered. The provider resolved a significant number of the discrepancies by submitting documentation of vendor invoices; however, not all of these discrepancies were resolved. The provider agreed that it did not have the vendor invoice documentation to resolve the remaining issues and agreed to repay $54,454.