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Licensees: understand your responsibilities in operating your pharmacies

November 14, 2018
Lessons Learned: Honesty and integrity are required in dealings with third-party insurers.

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 misconduct. Central to the allegations considered were numerous concerns raised by a third-party insurer about claims submitted by the pharmacy that were later determined to have been falsified, dishonest, incomplete, without authorization, and/or incorrect.

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 serious misconduct. The Hearing Tribunal found that his actions had harmed the integrity of the profession and warranted serious sanctions.

The Tribunal was also aware that the pharmacist had also complied with the findings of the third-party audit and had sold his pharmacy.

In this matter, the Tribunal imposed significant penalties, even though the pharmacist admitted his responsibility for all the allegations and acknowledged that he failed to exercise the professional and ethical conduct expected and required of an Alberta pharmacist and licensee. The Tribunal ordered

  • a suspension for a period of three (3) months;
  • a fine of $10,000;
  • the pharmacist not to be an owner, proprietor, or licensee of a pharmacy for a period of three (3) years;
  • a payment of the costs of the investigation and hearing [Note that the cost in this matter totalled $29,265.49]; 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 (3) years.

Rationale for the Tribunal’s decision, is reflected in its following statements from the Tribunal’s September 12, 2018, decision:

The insurer must be able to rely on the accuracy and truthfulness of the information that is submitted by a pharmacist. [The pharmacist’s] misconduct is not minor or trifling.  The Hearing Tribunal finds that [the pharmacist’s] actions were serious enough to constitute unprofessional conduct. 

Trust was clearly breached with the insurer which has the potential to have implications across the profession and into the public purview.   The tribunal did not view the conduct as minor and strongly feels that the issue goes deeper than a mistake with minor record keeping.  Appropriate recording keeping goes to the heart of the integrity of the profession.  There must be confidence that the information submitted to insurers is truthful and accurate.  The licensee plays a major role in providing oversight to these processes, it is central to the role as licensee.

Another lesson that can be learned from this matter is as follows:

  • Licensees, pharmacy owners, and proprietors must be aware that their actions and omissions may not only affect their standing with the ACP but can greatly impact on their pharmacists’ and pharmacy technicians’ ability to full comply with the standards of practice.

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 in the operation of your pharmacy.
  2. 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.
  3. Don’t assume or “cut corners”, especially when creating patient records or submitting claims to third-party insurers. When in doubt, ask and confirm.
  4. Always approach your, and your pharmacy’s, contractual obligations with honesty and integrity.