Information & Tools for Community Pharmacists

SmartD Rx (PDP) is not currently accepting enrollments due to CMS sanction action.
CMS has suspended all marketing and enrollment activities for SmartD Rx as of April 23, 2013.

Support for Community Pharmacists

Smart Insurance Company offers products designed and led with the input of pharmacists. We recognize that the pharmacist's role is pivotal - not only in the long-term health and wellness of seniors, but in assisting caregivers in managing the most critical aspects of taking prescription medications.

In addition, the expertise, advice and guidance of pharmacists are critical to those seniors who are at a higher risk of drug-related problems due to:

Multiple chronic illnesses

Using a number of different medications

Age-related changes in the effect of drugs

With extensive support to ensure that you can deliver personal prescription care, SmartD Rx helps you build relationships, improve satisfaction among loyal patients and drive new patients to your store.

If you are interested in becoming a SmartD Rx network pharmacy, or part of our Preferred Network powered by RxAlly, please call us at 1-877-723-6004.

Healthcare Setting Guidelines

To learn more about guidelines for provider marketing activities regulated by the Centers for Medicare & Medicaid Services, please click here.You will be leaving the SmartD Rx website.

Fraud Waste and Abuse

As part of our ongoing efforts to contain the rising costs associated with healthcare services and medications, we are committed to detecting, preventing, correcting and deterring acts or attempted acts of fraud, waste and abuse. Fraud, waste, and abuse result in resources being diverted for illegitimate purposes and results in increases of healthcare costs to those who are in truly in need. We are dedicated to providing information to our enrollees and providers about how to identify and report activities involving fraud, waste, and abuse.

What is Fraud, Waste, and Abuse?

Fraud - An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law.

Waste - To use health care benefits or spend health care dollars without finding a real need for the services or assets. For example, a doctor prescribing a medication for 30 days with a refill when it is not known if the medication will be needed beyond the initial period it was prescribed.

Abuse - Provider practices that are not consistent with sound fiscal, business or medical practices that result in unnecessary costs to the health care system, such as providing a prescription to a beneficiary that is not warranted by a medical diagnosis or condition.

How to Report Fraud, Waste, and Abuse

If you suspect fraud, waste, and abuse, you can contact us in one of these ways:

Phone: 1-888-328-0420
Email: PartDFraud@SmartDRx.com
Mail: SmartD Rx
ATTN: FWA Unit
P.O Box 1417
Mechanicsburg, PA 17055

Medicare: 1-800-MEDICARE (1-800-633-4227)

You can choose to report incidents of fraud, waste and abuse anonymously. Any information that is provided to us will be treated confidentially. We reveal the results of our investigations only to those authorities or individuals who have a legitimate reason to receive it (for example, federal and state law enforcement authorities, medical director, senior managers and legal department).

How We Investigate Allegation of Fraud, Waste, and Abuse

The nature of how we conduct our investigations depends on a number of related factors including the type of allegation being reported, the scope of people involved, among other considerations. Our investigations may include:

Contacting people who may have information regarding the allegations. We may contact a member, a physician, or a pharmacy to provide us with additional information so we can make an informed decision based upon detailed information.
Notifying the appropriate law enforcement or regulatory agency of suspected fraud. This would include, but not be limited to the National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC).

Identifying Fraud, Waste and Abuse

Some examples of fraud include, but are not limited to:

Agents can commit fraud by:
- Requesting a beneficiary pay their Medicare Part D premiums in advance.
- Enrollment of a beneficiary without their knowledge or permission.
- Misrepresenting the plan benefits being sold.
Prescribers can commit fraud by over-prescribing medications, or writing prescriptions for drugs that are not medically necessary, often in mass quantities.
Pharmacies can commit fraud by:

Billing for services not rendered.
Billing a Medicare Sponsor for prescriptions not dispensed (Phantom Claims).
Dispensing a generic drug to a member, but billing the Medicare Sponsor for a brand drug.
Dispensing expired or adulterated medications.

Beneficiaries or Members can commit fraud by:
- Misrepresenting personal information such as identity, eligibility, or medical condition in order to illegally receive a benefit.
- Forging or altering a prescription.
- Doctor Shopping, or utilizing several physicians and/or pharmacies to obtain multiple prescriptions of narcotics or controlled substances.
Anyone can commit fraud by:

Selling drugs on the black market, otherwise known as drug diversion.
Committing Identity Theft, or assuming the identity of another individual to in order to obtain a benefit.

FWA Training for First-Tier, Downstream and Related Entities (FDRs)

All FDRs are to conduct required education and training to identify, correct and prevent potential fraud, waste and abuse, as defined in the Federal Register for 42 CFR Part 423 of the Medicare Program and Section 50.3.2 of Chapter 9 - Compliance Program Guidelines of the Prescription Drug Benefit Manual.

To meet this requirement, SmartD Rx is requiring all FDRs to complete the CMS Medicare Parts C and D Fraud,
Waste and Abuse Training located on the CMS Medicare Learning Network® (MLN). To obtain these training materials, click here. You will be leaving the SmartD Rx website.

Deligated Entity FWA Training Attestation