When conducting an audit of a pharmacy, are prescriptions samples looked at for accuracy of dosing conversions (i.e.

Hello,
Thanks for the information. I've listed below some of the items that are audited during the process. As you will notice, there is nothing specifically stating they look at weight conversions. However, if suspicious or inaccurate (fraud and abuse) data shows up during their audit, they can review these to identify incorrect conversions.
Here is a list of audited items:
• High dollar claims
• Quantity change within a prescription number
• High volume of claims per member
• High volume of controlled substances
• Unusual or unlikely drug combinations
• Apparent high dose
• “Doctor DAW” code claim submissions
• Compliance with FDA Risk Management Program requirements
• Quantity dispensed is within plan limits
• High number of refills
• Compliance with State and Federal laws and rules
• Amount paid for compounds is appropriate
• Random Claims
• Insufficient directions (e.g. UAD)
• Missing prescription
• Overbilled quantity
• Generic dispensed, brand billed
• Different drug billed
• No Signature Log
• Cut quantity
• Inaccurately billed compound
• Invalid prescription
• Wrong directions on dispensed prescription
• Invalid use of DAW codes
• Return-to-stock procedures (procedures for reversing claim billings for prescriptions not picked up)
• Medicare D program requirements
• Review of purchase invoices
• Contacting the prescriber-of-record for validation
• Contacting the patient for validation of receipt of medications
• Billing for non-existent prescriptions (phantom claims)
• Billing for brand drugs when generics are dispensed
• Billing for prescriptions that are filled but never picked up (e.g., not
• reversing claims)
• Inappropriate use of dispense as written (DAW) codes
• Drug shorting, where pharmacy dispenses less than prescribed quantity
• and intentionally bills for the full amount prescribed
• Prescription forgery or alteration (i.e. submitting altered receipts for
• reimbursement)
• Known coordination of benefits discrepancies:
• Hard-copy prescriptions;
• Computerized dispensing records;
• Physician records to support prescription records;
• Patient signature logs;
• Purchase records and invoices;
• Policies and procedures;
• Financial records;
• Communications logs;
• Provider payment records;
• Contracts;
• Quality control plans;
• Clients and membership eligibility records and contracts; and
• Computer flowcharts and programs.
I hope this helps. If so, please click the ACCEPT button.
Thanks!