In late 2017, Kmart Corp. agreed to pay $32.3 million to settle a whistleblower lawsuit claiming its pharmacies overcharged federal health care programs and some private insurers for generic prescription drugs. In one case, according to the suit, Kmart sold a 30-day supply of a drug for $5 to customers of its discount program but filed for reimbursement from the government for $152 for the same drug for its Medicare customers.
Fraud. This case is another example of why it is so important for self-insured employers to insist upon an annual healthcare claims audit. A 100% Difference comprehensive healthcare claims audit by Healthcare Horizons can uncover cases just like this where a pharmacy or provider overcharges one type of client and not another. Healthcare Horizons works with its clients to recover overpayments and prevent the same kind of overcharging in the future. Unless employers perform an annual comprehensive audit, fraud and waste can go undetected for years, costing them money they could be using to run their businesses.
The Difference is in Knowing.
Visit Healthcare Horizons today to learn more, or contact us at hhadmin@healthcarehorizons.com to discuss a healthcare claims audit assessment.
Randy King is president of Healthcare Horizons Consulting Group, Inc., which has performed healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.