In successive weeks, Boesen and Snow has obtained two favorable decisions through a PBM’s Appeal Hearing Process that reversed Network Terminations due to audit findings. The firm collaborated with each client to prepare thorough responses to initial and final audit findings and termination appeal hearing presentations that convinced the PBM to quickly rescind the decisions to terminate.
In the first matter, the PBM had wrongfully associated a compounding pharmacy’s dispensing of valid prescriptions with business practices that the Center for Medicare and Medicaid Services (CMS) had identified as potentially fraudulent. Boesen and Snow helped the client present its dispensing records along with peer-reviewed clinical studies and told the impressive story of this reputable business with a positive impact on its community.
In the second matter, Boesen and Snow worked with the pharmacy to dispute undisclosed member denials with records of member authorizations and payment and delivery tracking evidence.
PBM audits can result in enormous financial losses due to recoupment, payment suspensions, and network terminations. Boesen and Snow has the unique background of over 20 years of combined pharmacy and PBM operational experience necessary to defend pharmacies on the unequal playing field that PBM audits present. Contact Boesen and Snow Law today if your pharmacy has been notified of a PBM audit.