Rollover prescription processing for assisted living facilities
Brattle was retained in an FCA matter brought against a pharmacy chain accused of failing to develop an operational system necessary to ensure regulatory compliance. The chain allegedly sought reimbursements for prescription drugs dispensed to patients in assisted living facilities without valid prescriptions. The pharmacy would then allegedly rollover expired prescriptions and continue to dispense the drugs without physician authorization. Brattle structured and analyzed the raw data from discovery, covering millions of prescriptions, and matched that data to outside data on reimbursements for those prescriptions. This work optimized the time and review of the final documentation. Using certain criteria, Brattle’s analysis was used by a subject matter expert to identify a number of apparent invalid prescriptions per patient, as well as the corresponding dollar amounts the pharmacy chain billed to Medicare and Medicaid.