Audit Look Backs: How Long Is Long Enough?

NCPA supports Rep. Doug Collins (R-Ga.) for his letter to key House committee leaders questioning the wisdom of PBMs being able to audit Part D pharmacies on 10-year-old claims. “If there are bad actors in pharmacy they certainly should be audited,” Collins says, “but why should the PBM need 10 years to begin an audit to uncover fraudulent activity?” Medicare hospital audits only look back three years and the same should apply to pharmacies, he suggests. Also, he hopes any recouped funds ultimately get back to Medicare. Unfortunately, that is often not the case.