Cheating Chain Pharmacies & Beyond

Cheating Chain Pharmacies & Beyond

In recent years, there has been a growing focus on the issue of cheating in the healthcare system. This cheating can take many forms, from pharmacists falsifying patient records to doctors prescribing unnecessary medications.

One of the most common forms of cheating in the healthcare system is the manipulation of metrics. Metrics are used by hospitals and other healthcare providers to track their performance. They can measure things like the number of patients seen, the number of tests performed, and the number of prescriptions filled.

In order to improve their metrics, some healthcare providers have been caught cheating. For example, in 2017, CVS Pharmacy was fined $20 million for falsifying patient records. The company had been inflating the number of patients who had received flu shots in order to meet its performance goals.

Another form of cheating in the healthcare system is the sharing of secrets. When chain pharmacists meet, they often share tips on how to cheat the system. For example, they might discuss how to falsify patient records or how to bill insurance companies for unnecessary services.

This sharing of secrets is a major problem because it allows cheating to become widespread. It also makes it difficult for regulators to catch cheaters.

The cheating culture in healthcare is not limited to pharmacists. Doctors, nurses, and other healthcare providers have also been caught cheating. For example, in 2016, a doctor in Florida was arrested for prescribing unnecessary medications to patients. The doctor had been doing this in order to generate more revenue for his practice.

The cheating culture in healthcare is a serious problem. It puts patients at risk and it undermines the public's trust in the healthcare system. It is important to hold healthcare providers accountable for their actions and to create a culture of integrity in the healthcare system.

In addition to the examples mentioned above, here are some other examples of cheating in the healthcare system:

  • Hospitals billing for procedures that were never performed
  • Doctors prescribing unnecessary tests and medications
  • Nurses falsifying patient records
  • Medical device manufacturers bribing doctors to prescribe their products

The cheating culture in healthcare is not a new problem. It has been going on for many years. However, in recent years, there has been a growing focus on this issue. This is due in part to the increasing number of lawsuits and investigations into cheating in the healthcare system.

For example, in 2019, a study by the Government Accountability Office found that nearly one-third of hospitals had been investigated for billing fraud in the past five years.

In 2020, the Department of Justice announced that it had recovered over $2 billion in settlements and fines from healthcare providers for fraud and abuse.

A 2021 survey by the American Medical Association found that 70% of physicians believe that cheating is a problem in the healthcare system.

"The cheating culture in healthcare is a serious threat to patient safety and the public's trust in the system," said Karen Ignagni, President and CEO of the American Hospital Association.

"We need to do more to hold healthcare providers accountable for their actions and to create a culture of integrity in the healthcare system," said Mark McClellan, former administrator of the Centers for Medicare & Medicaid Services.

"Cheating in healthcare is a problem that we cannot afford to ignore. It puts patients at risk and it undermines the public's trust in the system," said Dr. David Blumenthal, President of the Commonwealth Fund.

The cheating culture in healthcare is a serious problem that needs to be addressed. Healthcare providers, regulators, and the public must all work together to create a culture of integrity in the healthcare system.

There needs to DIR fee reform. PBMs are the main reason why people cheat insurance audits and Medicare. Fraudulent practices are occurring all over the pharmacy world and expenses such as high procurement costs, increasing tech wages, frozen pharmacist wages, ever increasing DIR fees, etc. put more pressure on businesses to generate revenue. Profitably? Most pharmacies have been operating at a loss or barely breaking even for over a decade. The incentives to not cheat are less and less every year due to increasing demand for services and lower payouts from reimbursements. Nice articles though...

Steve Malen PharmD/MBA

Director of Strategic Partnerships at Town & Country Compounding

1 年

Any other examples of cheating that you witnessed in pharmacy or in healthcare? Will you stay silent or will you whistleblow to change this CULTURE of CHEATING to a CULTURE of CARE with me?

Steve Malen PharmD/MBA

Director of Strategic Partnerships at Town & Country Compounding

1 年

Finally, at independent pharmacies across the country trying to survive. You are not innocent however since you are owned by the little guy I will say I at least empathize. I will not disclose the ways they cheat however I will say let's create legislature such as the recent changes in New Jersey to increase the ability for pharmacies to make a profit. Curious to hear your input Dr. Lisa Faast - Pharmacy Badass regarding making a profit without cheating. Is it possible?

Steve Malen PharmD/MBA

Director of Strategic Partnerships at Town & Country Compounding

1 年

Let's get specific now with CVS Pharmacy. Every Friday the pharmacists would generate new prescriptions off of adherence reports called PCQ calls artificially increasing drug adherence numbers which would then be used to report to companies like IBM that they can help "manage" their drug spend. Investor fraud, insurance fraud, and board of pharmacy violation out the wazoo.

Steve Malen PharmD/MBA

Director of Strategic Partnerships at Town & Country Compounding

1 年

Let's get specific. At University of Rhode Island the "professional" fraternities and sororities all had test banks for all the major exams. So you pay $300 per year to have access to answers to all the exams. Kappa Psi Pharmaceutical Fraternity is this still happening?

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