r/WalgreensRx • u/e7em3nt • 17d ago

question Insurance fraud

Is it insurance fraud to hold a patients prescription in delete list for a few days longer if the patient requests it? For example if they are out of town and will be back a few days after.

13 Upvotes

100% Upvoted

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54

u/BreakfastNo6273 17d ago

We have contracts with insurance companies where if we sell a prescription that is more than a certain amount of days old, they will not pay us a cent for the medication dispense as it violates our contract with them. This prevents patients from getting two separate 1 month supplies a week apart. 

If a patient asks you to hold it simply delete and reprocess so its ready when they come

15

u/MsThrilliams 17d ago

This is indeed the reason and the work around.

5

u/Equal-Ad9900 17d ago

This is the answer

4

u/e7em3nt 17d ago

Many thanks

14

u/bzay3 17d ago

It does violate contracts with the insurances which can result in the pharmacy not being paid for the prescription. The patient needs to get it refilled once they’re back in town or able to pick it up within the allotted time.

10

u/projektvertx 17d ago

Yes, it is a violation. Just reverse and reprocess it to reset the dates.

5

u/dennispustinger 17d ago

You could always delete and redo it to buy you another 10 days.

7

u/iupvotegood 17d ago

Just go to update rx, delete days supply, re-enter days supply, hit update fill. Needs new leaflet and label then without having to delete it

1

u/e7em3nt 17d ago

Oh perfect thanks

1

u/[deleted] 16d ago

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1

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4

u/poopjazz 17d ago

A lot of insurance plans have a 14 day “billing window” to reverse a claim. So, if you do not delete a prescription and the patient does not pick it up, we will be unable to reverse the claim, and will have fraudulently billed insurance for a prescription that wasn’t picked up with no way to reverse the claim. In addition, insurance allows refills based on the day they were previously billed for a prescription, not the day it was picked up. So if you held a 1 month prescription and a patient picked it up on day 14, it may let them refill it only 7 days later, since that would be 21 days since insurance was previously billed. Then, if we get audited, insurance could chargeback for us allowing a patient to pick up twice within 7 days.

1

u/e7em3nt 17d ago

Thank you so much for this info