Illinois PBM Pharmacy Audits Defense Lawyer

Defense for PBM and Insurance Pharmacy Audits in DuPage County, Illinois, and Throughout the Country

In the healthcare industry, pharmacy benefit managers (PBMs) serve as intermediaries between a pharmacy and the insurance company. PBMs negotiate rates between pharmacies and drug manufacturers and process the vast majority of all medical prescriptions. Because of the major role they play, pharmacies cannot conduct business without contracting with a PBM. Most often, these contracts give the PBM the right to audit a pharmacy to ensure all guidelines are being followed. If you are a pharmacy facing a PBM or insurance audit, it is important to consult with experienced legal counsel, so you know how to prepare for a favorable outcome.

For over 16 years, The Law Offices of Joseph J. Bogdan, Inc. has consulted and represented countless clients for PBM pharmacy audits and other concerns affecting licensed professionals. Joseph Bogdan is both an attorney and a registered pharmacist with extensive medical and legal experience. Attorney Bogdan has a Pharmacy Doctorate and is a board member of the Illinois Pharmacist Association. He is frequently called as an expert witness in pharmacy-related cases. He also teaches Pharmacy Law at three Chicago-area universities.

Attorney Bogdan understands the challenges pharmacists and pharmacies face with licensing and audit issues. He represents pharmacists before state Boards of Pharmacy, including the Illinois Board of Pharmacy. He also provides legal representation for the buying and selling of pharmacies, and represents clients for both PBM and Medicare/Medicaid pharmacy audits, as well as DEA pharmacy investigations. Attorney Bogdan has in-depth knowledge of the written agreements typically signed between pharmacies and PBMs, and he puts his experience to work to adopt a proactive and aggressive approach, ensuring that the rights of pharmacies are protected.

Pre-Audit Consultations

PBM pharmacy audits can occur for a number of reasons. Some pharmacies are selected for an audit at random, while at other times, an audit might be triggered by a certain set of factors during the analysis of a claim. It is important for pharmacies to prepare for PBM audits well ahead of time to ensure they are in compliance with all of their obligations. Advance preparation helps ensure the audit process goes much smoother. Attorney Bogdan provides pre-audit consultations; including a thorough review of all agreements, contracts, and policy manuals to determine if there are any areas which may need to be addressed. He can also help prepare you for the audit process, what to expect, and how to deal with the auditor.

Post-Audit Consultations

If an audit has already occurred, and you have received a report of finding from the PBM, Attorney Bogdan can review the report and advise you on your best options going forward, including legal recourses you may have if the PBM has issued a request for recoupment of monies from the pharmacy.

If you are in need of any kind of assistance with pharmacy audits in Illinois, Attorney Bogdan is here to help. For a free consultation, contact our office today at 630-310-1267.