Attestations & Certifications Pharmacy Compliance Guide

Every fall we hear the PBMs sending out requests for Attestations for Fraud, Waste and Abuse, and HIPAA Compliance. Why do they all keep asking for the same information? When Medicare Part D came into play, the Pharmacy Benefit Managers were given the regulatory authority to manage the Medicare Part D program. Part of this program was ensuring pharmacies were properly training their staff. It initially started with annual: Fraud, Waste & Abuse Training, OIG Exclusion Verification, and HIPAA Compliance Training Then each fall, everyone had to attest they accomplished these requirements for Medicare Part D. Unfortunately, a lot of pharmacies and organizations signed off of the attestations and really didn’t do it. The attestation is a legal statement where the individual, the pharmacy owner and/or the pharmacist-in-charge were legally attesting they were accomplishing the training and had no documentation to support their claim. Legally this was a false claim under Medicare Part D and the PBM can and did recoup all Part D reimbursements from the pharmacy, which was devastating. The PBMs then added to their requirements over the years making them a sticker and more overbearing. Most especially is the OIG Exclusion verification requirement. Only pharmacy in all of the healthcare must accomplish this task every month. It started with just one database, the Office of Inspector General, then was added to the General Services Administration (GSA) and the Systems for Award Management (SAM). The GSA and SAM have publicly merged into one, but as of today, we are still receiving a database from each of them. In addition, individual states are developing their own exclusion lists that must be checked. There is no standard for the lists. Some are managed by the health departments, others by the Attorney General or the Treasury Department.