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Medicaid Providers, Beware: OMIG Places Provider Compliance Programs Under Review
The NYS Office of the Medicaid Inspector General ("OMIG") has dramatically increased enforcement activity in connection with Medicaid provider compliance programs: OMIG is notifying providers that their compliance programs are being placed . . .
On October 24, 2018, the President signed a new bill aimed at combating the opioid addiction epidemic that is sweeping the nation - the SUPPORT Act of 2018. The full Congressional summary of the the . . .
The Importance of Fresh Perspectives When Challenging PBM Audit Findings and Termination Notices
It is a familiar story - a pharmacy provider receives a PBM termination notice or audit findings, believes that nothing can be done, and gives up the fight. Providers often fall into the trap of accepting PBM's narratives and not . . .
A New Jersey Pharmacy Owner Charged With “Cash Skimming” Conspiracy – Is Your Pharmacy at Risk?
A New Jersey owner of several pharmacies was charged by indictment and arraigned today on charges of conspiracy to defraud the IRS by engaging in a "cash skimming" scheme. The indictment alleges that the pharmacy's owner, . . .
Importance of Addressing Third-Party Audits Properly
Third-party audits have the potential to wreak havoc on independent pharmacies.An audit on its own can be extremely costly due to time dedicated to gathering necessary documents and assisting the auditor. Further, any discrepancies . . .
Medicare Appeals Backlog – Light at the End of the Tunnel?
The number of Medicare appeals cases pending to be heard by administrative law judges has been growing exponentially. The backlog is now almost ten times larger than it was five years ago and is projected to reach two million . . .
Merger Mania: Exploring the Impact of ESI/Cigna and CVS/Aetna Mergers on Independent Pharmacies
In a ground-shaking two weeks, the Antitrust Division of the U.S. Department of Justice approved multiple PBM/insurer mergers: first, the merger of Express Scripts Inc. and Cigna, and now, the merger of CVS Health (formerly CVS Caremark) . . .
HHS Echoes Importance of HIPAA Compliance for Closed Businesses
Recently, HHS reiterated that severe consequences can be imposed for HIPAA violations, regardless of whether a business is still operational. If HIPAA violations were committed, a business can be charged long after its doors close. Moreover, . . .
CMS has released a list of updated final adverse actions that need to be reported to CMS in a timely fashion. The list includes, but is not limited to, certain convictions, exclusions, and revocations, regardless of whether records are expunged. Additionally, CMS revoked certain requirements . . .
Physical Therapy Practices are Growing – But Also Face Increased Challenges
2006 was a monumental year for New York physical therapists – New York State passed a law permitting physical therapists to directly treat patients without a referral from a physician, triggering an explosion of private physical therapy . . .
Can a Physician’s Medical Judgment be Basis for a False Claims Action? Appellate Court Rules Yes.
A doctor's certification or medical judgment regarding a certain treatment can be considered "false" if the treatment is not considered "reasonable and necessary" under the government's definition, even if the terms are not defined for the specific medical treatment.
Nationwide Crackdown Charges 601 Individuals with Over $2 Billion in Healthcare Fraud
In a sweeping crackdown that vastly exceeded investigations of years' past, the U.S. Department of Justice and Medicare Fraud Strike Force charged 601 individuals with over $2 billion in healthcare fraud. In Brooklyn and Long Island alone, . . .
New Jersey Act Imposes New Requirements to Protect Consumers
New Jersey providers should be alert to the recently signed into law Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act.The Act pertains to, and enhances, consumer protections related to out-of-network . . .
New York State Takes Action Against Abusive PBM Audits, Grants New Protections to Independent Pharmacies
The recently passed New York State budget bill including sweeping new protections for independent pharmacies facing PBM audits. The bill, which amends the Public Health Law, requires PBMs, when conducting audits, to accept . . .
What NYC Employers Must Know About the Safe Leave Law
The former NYC Earned Sick Time Act, popularly known as the Paid Leave Law, is now the Earned Safe and Sick Time Act. Previously, the Act obligated employers to provide a certain amount of sick leave for their employees. The . . .
New York State Imposes Limitations on LHCSA Applications
Recently, New York State implemented a two-year moratorium on the processing and approval of applications for licensure of Licensed Home Care Service Agencies ("LHCSAs").This moratorium suspends the Department of Health's processing . . .
Healthcare providers are increasingly feeling the cost of employing excluded individuals.Indeed, over the past year, the number of enforcement actions taken against physician's offices, pharmacies and other entities employing excluded . . .