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Roche's Test Strips Lawsuit Targets Wholesalers,

On March 28, 2017, Roche Diagnostics Corp. and Roche Diabetes Care, Inc. filed a lawsuit in the U.S. District Court for the Southern District of Indiana, entitled Roche Diagnostics Corp. et al. v. Binson's Hospital Supplies, Inc., et al., ​Docket No. 17-cv-0949 (LJM)(DML). The Indianapolis-based subsidiaries of the . . .

In News and Updates

TOWARDS INCREASED PBM TRANSPARENCY

Is Increased PBM Transparency on the Way?

Newly proposed Federal legislation would increase PBM transparency regarding aggregate rebates and "spread pricing".An oft-controversial issue, independent pharmacy associations have long lobbied for greater disclosure of the rebates that PBMs receive from drug companies, which . . .

In News and Updates

INSURANCE PLAN NOT PERMITTED TO “CROSS-PLAN”

A Federal District Court in Minneapolis has issued a highly favorable decision for physicians and healthcare providers on the limits of an insurance plan's ability to recoup.  Specifically, the court ruled that insurers can only recoup against providers from the same health plan that the alleged overpayment was issued . . .

In News and Updates

MDRXLaw 2017 Q1 Newsletter - Focus on PBM

We are pleased to announce the publication of our 2017 First Quarter Newsletter devoted to the issues facing pharmacies in connection with PBM audits.

In News and Updates

MFCU Takes Recoupment Actions Against Providers

Calling the attention of every New York Medicaid provider reimbursing its billing/collection agents on a percentage basis, the New York State Medicaid Fraud Control Unit (MFCU) has recently sent out recoupment letters demanding repayments of Medicaid funds paid to billing companies under fee-splitting . . .

In News and Updates

MEDICARE APPEALS BACKLOG MUST BE CLEARED,

In a groundbreaking decision addressing one of the most pressing issues currently faced by Medicare providers, the U.S. District Court for the District of Columbia ordered CMS to clear the lengthy backlog of Medicare appeals at the administrative law judge (ALJ) level.

Under the Medicare Act, CMS must provide an ALJ . . .

In News and Updates

PROTECTING ACCESS TO PHI

As providers continue to rely on software vendors to maintain protected health information ("PHI"), a well-drafted business associate agreement ("BAA") becomes increasingly important. The BAA will set forth the obligations between providers and business associates such as software vendors with respect to the PHI.

Software . . .

In Healthcare Publications

A GUIDE TO NY & NJ INTEGRATED CARE FACILITIES

New regulations governing integrated care are affording health care providers and facility operators a cost-effective opportunity to expand the range of treatment services they offer. As is true in the early stages of any significant regulatory shift, it is vital for providers and operators to stay aware of the complex regulatory developments that affect integrated care facilities.

New York and New Jersey recently adopted facility models . . .

In News and Updates

AGENCY PROFILE: MEDICARE FRAUD STRIKE FORCE

This is the first article in an educational series to appear on the MDRXLaw Blog, profiling various regulatory and law enforcement agencies and entities relevant to health care providers. Given the number of agencies and entities having jurisdiction over health care providers, the individual role played by each can often be unclear. This post will profile the Medicare Fraud Strike Force, an interagency law enforcement collaboration.

In . . .

In News and Updates

Unprecedented National Health Care Fraud

NEWS BRIEF: Unprecedented National Health Care Fraud Crackdown; 301 Individuals Charged; $900 Million in False Billing Alleged

The joint DOJ-HHS Medicare Fraud Strike Force and twenty-three state Medicaid Fraud Control Units executed an unprecedented nationwide sweep earlier this week, announced as the largest health care fraud . . .

In News and Updates

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