Medicor changing NDC#'s to lower cost meds (California)

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Medicor changing NDC#'s to lower cost meds (California)

Postby rider001 on Mon Apr 06, 2009 2:20 pm

I am wondering if anyone has noticed that Medicore which does bill review for Tokio Marine systematically changes the NDC numbers of medication to lower costing mg.

Example i bill for Norco 10/325 #60 reimbursement $42.06. Medicore changes the NDC# to Norco 5/325 #60 reimbursement $14.73.

I have noticed weird underpayments beofre from them but this really caught my eye!

Of course i will be filling a complaint with the black hole, i mean audit unit.
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Re: Medicor changing NDC#'s to lower cost meds (California)

Postby gaiassoul1@yahoo.com on Mon Apr 06, 2009 3:07 pm

better yet, file a bunch of petitions for contempt, sanctions and costs...then file a petition for consolidation at each board....only way to draw a line in the sand to get them to stop.

IF they get two penalties against the same adjusting location, you have just established pattern and practice...that might make them pay attention.
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Re: Medicor changing NDC#'s to lower cost meds (California)

Postby rider001 on Mon Apr 06, 2009 4:24 pm

I don't quite have enough history yet although what you suggest sounds fun.
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Re: Medicor changing NDC#'s to lower cost meds (California)

Postby jonbrissman on Mon Apr 06, 2009 8:38 pm

Are you discussing repackaged drugs? If so, please identify the time frame during which they were dispensed. There are different strategies that defendants could use for reimbursing repackaged drugs 1) prior to 2004; 2) between 01/01/2004 and 03/01/2007; and 3) after 03/01/2007.

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Re: Medicor changing NDC#'s to lower cost meds (California)

Postby rider001 on Tue Apr 07, 2009 8:04 am

JonBriss
Dispenced 1/8/09. I think you will be hard pressed to come up with a defense for this one. From my eyes this is a blatent and intentional attempt to cost control. Under no circumstances is a IC or their bill review company allowed to change NDC#'s. For one these are controls and are report to the state. Secondly they cannot change the NDC# to a product which strength we did not dispense. On this particular bill Norco (which is essential vicodin but stronger) they changed the NDC# to reflect a lower dosage because it pays lower. On the same bill they used an NDC# for Zolpidem (generic Ambien) with an increased strength which guess what also pays lower.

I billed Hydrocodone/APAP 10/325mg(Norco)
Bill review changes to Hydrocodone/APA 5/325mg
I billed Zolpidem Tartrate 5mg(Ambien)
Bill review changes to Zolpidem Tartrate 10mg

With no explantaion.
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Re: Medicor changing NDC#'s to lower cost meds (California)

Postby jonbrissman on Tue Apr 07, 2009 4:00 pm

Rider, my expertise is in attacking defendants for mis-reviewing repackaged drugs prior to 03/01/2007. All I can tell you about a prescription dispensed in 2009 is that the fee schedule controls. Nonetheless, I am certain (as you are) that defendants may not substitute a NDC number that reflects a drug with a different dosage.

In addition to the Audit Unit. why not send a complaint to the Department of Insurance? Certainly if a provider billed for a different dosage than he furnished, the Dept. of Ins. would be charging that provider with fraud; so why isn't it also fraud when defendant does the same thing?

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