Preventing Fraud, Waste and Abuse in the Pharmacy

At conclusion, pharmacists and pharmacy technicians should be able to:

• Describe the role of the Centers for Medicare/Medicaid Services (CMS).
• Define CMS Medicare/Medicaid Fraud, Waste and Abuse (FWA).
• Describe specific examples of FWA in the pharmacy.
• Identify the prominent government agencies responsible for combatting FWA.
• Discuss the continued efforts of regulatory agencies to reduce fraud, waste, and abuse.
• Identify the major laws and regulations addressing FWA such as, Medicare regulations on Part C & D, HIPAA, the False Claims Act, the Anti-Kickback Statue, and others.
• Recognize conditions for participation in government funded programs for health providers.
• Define terms associated with FWA compliance like First tier, Downstream and Related entity.
• List the seven elements required for an approved compliance program.
• Recognize the consequences for non-compliance of program requirements.
• Identify FWA reporting procedures and reporting sites.
• Recognize protections under the Whistleblower Protection Act and the False Claims Act.
• List disciplinary actions and penalties for FWA violations.
• Explain the Exclusion List and the consequences of being on it.
• Identify record retention and attestation requirements for FWA compliance auditing.
• Identify other forms of health care fraud, waste, and abuse.
• List specific actions a pharmacist can take to prevent, identify, and correct FWA.