Question of the Day August 29, 2014 Should PBMs recoup claims and immediately terminate Network Proviider for all claims relating to compounding pharmacies who have been using form/check the box that were in violation of the Provider Manual? How much total money could be recouped from this violation alone?
Pre-printed prescriptions were at issue with respiratory (nubulizer) compounding decades ago, leading to questionable reimbursements under Medicare Part B (the unapproved drugs may not have been intended by prescribers, and, at the very least, the preprinted forms did not include material facts about the products--seems they have resurfaced here, particularly with respect to pain cream concoctions. Claims are made on the benefit side, with little or no risk disclosure.
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