Prescription insurance fraud
If a resident in a long term care facility has a medication reordered through the nurses at the facility and his Med D insurance plan denies the refill electronically as a refill too soon to the long term care pharmacy... is it breaking a law or committing insurance fraud if the med is sent out today and is not payable till tomorrow or the next and the dispense date is changed to the date the insurance will pay the claim? Essentially, the long term care pharmacy is sending the med out "no charge" until a day or two later when it would be payable by the plan. Of course, billing for a med today and then NOT dispensing it until tomorrow definitely falls into the fraud category. Medicare D insurance has a narrow window of when a claim is payable which in the LTC setting, can make the drug supply at the facility run too short. If a patient spits a pill out or one is dropped, the med may have to be dispensed a day or two before the insurance says it is payable again.