Jay Adzema runs Adzema Pharmacy in McCandless, Arizona. It is a one-store pharmacy that processed 20,000 prescriptions over the past two years. 90% of those scripts cost less than $50 a piece.
Recently, Express Scripts, a leading Pharmacy Benefits Manager (PBM) audited Adzema Pharmacy. The PBM was only interested in 19 of the 20,000 prescriptions.
These 19 prescriptions cost between...Read More
Benjamin Poehling, a former UnitedHealth Group employee, recently gave his first interview since having been publicly named as a whistle-blower. Poehling describes how UnitedHealth allegedly gamed the system to bilk the Medicare-Advantage program. To read the full article go to A Whistle-Blower Tells of Health Insurers Bilking Medicare
On March 27, 2017, the Office of the Inspector General (OIG) posted a 52 page comprehensive document entitled, “Measuring Compliance Program Effectiveness: A Resource Guide.” The Resource Guide can be found here. The Resource Guide provides seven program elements and hundreds of metrics that organizations can utilize to measure the effectiveness of their compliance programs.
Every organization...Read More