Medicare and Medicaid pharmacy audit support

Why government payer audits need extra care

Audits connected to Medicare and Medicaid programs carry high stakes for an independent pharmacy, and the documentation standard is demanding. A response should be complete, consistent, and traceable to source records. We help you understand what is being reviewed and what evidence each claim needs.

How we build the response

We start with the audit request or findings and the claims involved. We then reconcile those claims against wholesaler invoices and dispensing records at the National Drug Code level, taking account of equivalent products, pack sizes and units of measure. The result is an organized response that a reviewer can check claim by claim.

When to bring in an attorney

Some government payer matters call for legal representation. Pharma360 provides that through licensed audit-defense attorneys, under a separately scoped engagement starting from $495 per hour. Our consulting team keeps working on the records and reports while the attorney handles the legal side.

Start with a free consultation

Have the audit letter, the response date, the program or plan involved, and any claim list or findings ready. The first 30–60 minute phone or Zoom consultation is free, one time. Before billable work begins, you get a written estimate and a firm cost cap.

Questions about medicare & medicaid audits