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Shortcuts can prove costly

January 12, 2022

Lessons learned: Be thorough when working with third-party insurers and completing and maintaining pharmacy records.

A recent Hearing Tribunal issued its written decision on the merit and orders regarding the conduct of a pharmacist who was a pharmacy’s owner, proprietor, and licensee during the period of the alleged unprofessional conduct and misconduct. Central to the allegations were pharmacy record-keeping deficiencies, including concerns raised by a third-party insurer about missing supplier invoices.

The Hearing Tribunal found that the pharmacist failed to act ethically when she submitted claims to a third-party insurer without being able to provide the required supporting supplier invoices, without obtaining required patient signatures, and in excess of the allowable number of claims per day. Also, it was found that she failed to ensure her pharmacy had an effective record-keeping system and failed to create or maintain required and accurate pharmacy records. In doing so, the Hearing Tribunal found the pharmacist’s conduct was unprofessional and as a licensee she had engaged in misconduct. The Hearing Tribunal found that her actions had created the potential for patient harm and harmed the integrity of the profession, and therefore warranted serious sanctions.

The Tribunal also noted that the pharmacist was remorseful and accepted responsibility for her conduct, undertook to improve her pharmacy’s operations, had no previous findings of unprofessional conduct, fully cooperated with the investigation, and made full restitution to the third-party insurer ($83,897.73).

The Tribunal imposed significant penalties, even though the pharmacist admitted her responsibility for all the allegations and acknowledged that she failed to exercise the professional and ethical conduct expected and required of an Alberta pharmacist and licensee. The Tribunal ordered the following:

  • a suspension for a period of four months, with one month to be served April 1-30, 2022, and the other three months held in abeyance for three years, and then retired should there not be any similar concerns referred to investigation by the complaints director;
  • fines totalling $40,000;
  • the pharmacist must provide a copy of the written decision to the employer or licensee of any pharmacy where she works as a pharmacist for three years;
  • if the complaints director refers similar concerns to a hearing within five years, he may direct that the pharmacist cannot serve as an owner, proprietor, or licensee of a pharmacy for a period of three years; and
  • the pharmacist must pay 80 per cent of the costs of the investigation and hearing [estimated to be 80 per cent of approximately $24,000].

Rationale for the Tribunal’s decision is reflected in the following statements:

The regulatory framework that governs pharmacists makes it clear that record keeping is central to the role of both pharmacists and licensees.

Pharmacists are obligated to inform themselves of regulatory requirements.  The failure to comply with record keeping requirements is of great concern, since it has the potential to negatively impact public trust in pharmacists’ ability to provide services in a professional manner.

Licensees – incorporate these lessons into your practice:

  1. 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 when operating a pharmacy.
  2. Complete Parts A and B of the ACP Licensee Education Program (LEP) to learn more about the duties and responsibilities of a licensee.
  3. 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.
  4. Don’t assume or “cut corners,” especially when creating patient records or submitting claims to third-party insurers. When in doubt, ask and confirm.
  5. Keep current with the contractual requirements pertinent to your pharmacy’s third-party insurer agreements. Don’t guess when submitting claims for drugs, health care products, and pharmacy services.
  6. Take responsibility in preparing for, and participating in, third-party insurer audits. Have sufficient staffing available to properly respond to the audit requirements in a fulsome and timely manner.
  7. Review and consider your ethical responsibilities outlined in Principles 1 and 10 of the Code of Ethics. Always approach your, and your pharmacy’s, contractual obligations ethically, professionally, and with integrity.
  8. Ensure that all required pharmacy records are maintained in an authorized location and can be retrieved in an efficient, systematic manner.

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