Wilentz Attorneys Erase Prescription Audit Discrepancies

Wilentz Pharmacy Law Attorneys, Angelo J. Cifaldi and Joseph Carlo, recently overturned audit discrepancies regarding “invalid prescriptions” in full. It is no secret that PBMs have been contacting members in recent years to confirm whether prescriptions were received, whether co-pays were collected, and whether they saw a specific prescriber on a certain date.

This particular audit involved a member allegedly denying having seen their prescribing doctor on a certain date. Thus, despite these prescriptions being e-scribed and otherwise appearing completely legitimate to the dispensing pharmacy, the PBM sought recoupment of thousands of dollars for an “invalid prescriber relationship.”

In appealing said findings, Wilentz worked collaboratively with the client, submitting various attestations and other documents to dispel the notion that these were illegitimate prescriptions. Upon review, the PBM accepted the documentation and waived any alleged discrepancies.

Results achieved in prior matters are not meant to be a guarantee of success as the facts and legal circumstances vary from matter to matter.