A lot of the members I talk to complain about the centerwell pharmacy refilling their medications even though they tell them the medication has been discontinued or that they already have an ample supply resulting in the members getting a big supply of medications they don’t need. I imagine centerwell gets paid for all the unnecessary medications sent out. Is this fraud or just ineptitude?
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If only the infrastructure could support what we sell… we have outdated systems and our digital tools take months / years to implement. If we had a solid foundation, adherence and scripted volume wouldn’t be an issue. You can’t a product if there is no way to find it let alone make it accessible for repeat purchases.
They are playing the STARS game and since it's mail order and doesn't require a pick up, it gets filled. A fill shows med adherence even if the member never takes the meds. It is unethical and the big H has mastered that.
Absolutely illegal, immoral and unethical all in the name of profits. I feel another whi$tlebl@wer lawsuit coming!!
It's not cool.
It artificially inflates their med adherence scores and this results in increases in stars scores and thus payouts.
You should document and report this to CMS.