The Benefits of Pharmacy Canvassing in 2024

66% of Americans take one or more prescription drugs. This high statistics proves the treasure trove of information that a pharmacy canvass can provide about a patient.

By Carla Rodriguez | May. 10, 2024 | 5 min. read

 

Who gets canvassed really depends on the nature of the injury itself, but there is more overlap into areas you might not normally consider, and is why we are going to cover a lot of them.

First, we have the most common provider types that you would expect to engage during a medical canvass. These include hospitals, health clinics, and urgent care centers. These facilities often serve as primary points of medical care for individuals, making them key sources of basic treatment information. The more specific the places you are canvassing are the better information you can learn.

 

Medical Records and HIPAA

Pharmacies play a vital role in your quest for information. In fact, conducting a pharmacy canvass is one of the most effective methods to obtain a critical and relevant medical history. Think about it: more people than ever before are on prescription medication. Pharmacies have a wealth of information regarding the medications prescribed to individuals. By connecting with pharmacies, you can not only confirm the prescribing physician but also obtain valuable insights into treatment dates and medication usage. This information is invaluable in evaluating the claimant’s medical journey.

In the process of canvassing a pharmacy, the canvassing expert is only trying to get a “yes” or “no” from the pharmacy provider. There is no need to access protected information if the patient has never been a patient.  In a canvass, an investigator can ask for dates of service or at least confirmation as to whether the subject has received medication there. However, they cannot ask what medications or ailments the subject was being treated for.

You are probably asking yourself, is medical canvassing legal?

During a medical canvass, private investigators seek healthcare facilities where a claimant may have received treatment and the corresponding time frames. Importantly, they do not request specific medical information during this process. This is a process that heavily depends on communication techniques and social skills

Yes, If the claimant wasn’t treated at a particular facility, there’s no Protected Health Information (PHI) there. As long as the investigator doesn’t ask or seek PHI information during the canvass, they’re not violating HIPAA rules. Any further details about treatment require a subpoena, which can only be issued after the initial canvass. This is why any investigators that stigator doesn’t seek or obtain PHI during the conduct medical canvasses must be well-trained in this delicate process.

Pharmacies qualify as covered entities under the “supplier” subsection of 42 U.S. Code § 1395. This rule applies to all “protected health information (PHI).”

Pharmacy technicians receive HIPAA training early in their careers and are taught not to disclose protected information. The minimum penalty fine for exposing patient information is $137 and ranges up to $2,067,813 and can even include jail time. Therefore all healthcare workers are careful of the information they release and the handling of patient details.

Learn more about the legalities of Medical Canvassing in our blog, we go into more legalities and constraints you should be aware of while verifying your case.

 

Prescription Red Flags

The information obtained through pharmacy canvassing helps fill in important gaps in the claimant’s medical history. It provides insights into the types of medications prescribed, dosages, and the duration of treatment. This information allows you to assess the appropriateness of the treatment and evaluate any potential issues or inconsistencies.

In the natural course of claims verification, suspicions naturally arise for any number of reasons. Sometimes it means something, and sometimes not. We want to cover the main areas to be cognizant of so that if something were to cross your radar you’ll be all the more prepared to act on it. While not every red flag is indicative of fraudulent activity or inconsistencies, they serve as markers for further investigation. These red flags can include:

  1. excessive or prolonged use of medication
  2. frequent changes in prescribing physicians or pharmacies
  3. patterns of drug-seeking behavior
  4. discrepancies between reported injuries and the prescribed medication

 

What happens if the Patient Has Used this Pharmacy in the Past?

This is when record retrieval comes into play. This service is separate from a medical canvass during which a formal letter and the subject’s signed medical release are sent to the facility. Record retrievals can take longer and releases need to be acquired beforehand.

Many times a signed records release must be provided to the hospital or pharmacy or they simply will not cooperate. Sometimes, a hospital may even require that the release be their specific release and will not accept it from other facilities.

In the legal space, medical canvassing is valuable to the discovery plan. Often canvassing reveals treatment that the claimant intentionally or unintentionally omitted in their medical summary. Due to the quick turnaround time and availability of this information without requiring a signed medical release, this is a quick, informative option when done correctly.

Talk to our medical canvassing experts today and see if this service can help you avoid record retrieval.

 

 

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