Significant shifts in False Claims Act (“FCA”) enforcement were announced at the recent American Health Law Association (“AHLA”) Annual Meeting, as officials from the Department of Justice (“DOJ”) and Department of Health and Human Services (“HHS”) formally...
In light of recent trends, many pharmacies are considering using compliance consultants for PBM and governmental payor audits, often due to perceived cost savings compared to engaging legal counsel. While compliance consultants are valuable for routine compliance...
Over the past several months, we have seen a significant increase in audits and investigations targeting pharmacies for misrepresentations around prior authorization. In many of these audits, pharmacies are being accused of falsifying information or impersonating...
Receiving a subpoena from the Office of Inspector General (OIG) is a serious matter, often signaling a federal investigation into potential healthcare fraud or regulatory violations. These subpoenas require careful attention and a strategic response. As such, it is...
As healthcare providers look to streamline operations and improve efficiency, Management Service Organizations (“MSOs”) have become increasingly vital in helping medical practices, dental offices, and other healthcare entities manage non-clinical functions. MSOs...
Ketamine is rapidly gaining attention as a legitimate treatment for depression, PTSD, and chronic pain. While traditionally used as an anesthetic, its off-label therapeutic benefits have driven significant growth in ketamine infusion clinics and home-treatment...
In recent months, the New York State Office of the Medicaid Inspector General (OMIG) has ramped up the issuance of Medicaid enrollment denials for providers seeking to be enrolled in the New York State Medicaid Program. These denials are often based on vague or...
ph Recent developments suggest that significant efforts to curb abuses and harmful practices of Pharmacy Benefit Managers (PBMs) may be on the horizon. Both the Federal Trade Commission (FTC) and major media outlets have increased scrutiny on PBM practices,...
The Corporate Transparency Act (CTA) is a new law that affects small businesses in the U.S., including LLCs, corporations, and professional entities. Its main purpose is to help stop illegal activities like money laundering by making business ownership more...
We would like to remind New York healthcare providers about a significant regulatory aspect that impacts the way private insurers handle medical necessity disputes in New York. This is particularly relevant for those engaged in dealing with insurance audits or...