Operate your pharmacy ethically and responsibly
July 24, 2019
Lessons Learned: Honesty, integrity, and record keeping are fundamental for dealings with third-party insurers.
A recent Hearing Tribunal issued its written decision on the merit and orders about the conduct of a pharmacist who was a pharmacy’s owner, proprietor, and licensee during the period of the alleged misconduct. Central to the case were numerous allegations raised by a third-party insurer that “claims” submitted by the pharmacy were incorrect, incomplete, without authorization, and/or without supporting purchase records. These allegations were determined to be well-founded by the Hearing Tribunal.
The Hearing Tribunal found that the pharmacist, as the licensee, was the person most responsible for the operation of the pharmacy, including the pharmacy’s submission of the audited claims to the third-party insurer, and the creation of the associated patient records. In doing so, the Hearing Tribunal found the pharmacist’s conduct was unprofessional and, as a licensee, he had engaged in misconduct. The Hearing Tribunal found that his actions had harmed the integrity of the profession and warranted significant sanctions.
In this matter, the Tribunal imposed significant penalties, even though the pharmacist admitted his responsibility for all the allegations. The pharmacist alsoacknowledged that he failed to exercise the professional and ethical conduct expected and required of an Alberta pharmacist and licensee, had no previous disciplinary record, was remorseful and cooperative with ACP, and repaid the amount owed to the third-party insurer.
The tribunal ordered the following:
- a suspension of the pharmacist’s practice permit for a period of four months, with one month to be served and the other three months held conditionally in abeyance for a period of three years;
- fines totalling $30,000;
- the pharmacist not to be an owner, proprietor, or licensee of a pharmacy for a period of three years;
- a maximum payment of $15,000 towards the costs of the investigation and hearing; and
- the pharmacist to provide a copy of the written decision to the licensee of any pharmacy where he works as a pharmacist for three years.
Licensees—incorporate these lessons into your practice:
- Review the Pharmacy and Drug Act, the Pharmacy and Drug Regulation, and the Standards for the Operation of Licensed Pharmacies with regard to your responsibilities in the operation of your pharmacy.
- Review and discuss your obligations and the professional requirements of the pharmacy with your pharmacy’s owner and pharmacy staff to ensure that the pharmacy has the resources needed to meet these obligations.
- Don’t assume or “cut corners,” especially when creating or maintaining patient records or submitting claims to third-party insurers. When in doubt, ask and confirm.
- Always approach your, and your pharmacy’s, contractual obligations with honesty and integrity.
- Understand that pharmacy purchase records for drugs and health care products MUST be maintained at the pharmacy.
Another lesson that can be learned from this matter:
- Licensees, pharmacy owners, and proprietors must be aware that their actions and omissions may not only affect their standing with ACP but can greatly impact on their pharmacists’ and pharmacy technicians’ ability to full comply with the standards of practice.