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...

Recently, home infusion pharmacies have faced formidable challenges stemming from underpayment, untimely payment, and non-payment by major medical plans for infusion therapies. This pervasive issue affects both in-network and out-of-network providers across the...

MEDICAID/OMIG Compliance Policies and Reviews Are More Critical Then Ever Beginning July 2023, and very actively since then, NY Medicaid, through OMIG, has been conducting compliance program reviews to determine if required providers had adopted, implemented, and...

In the recent weeks, the New York State Office of the Medicaid Inspector General (OMIG) has conducted numerous unannounced on-site pharmacy visits as part of their new investigative initiative. At the time of the on-site audit, a letter referring to a Credential...

  In February 2023, New York State proposed Senate Bill S4007, which aims to introduce regulatory oversight of certain healthcare transactions involving private equity firms. The proposed law would apply to various healthcare entities, including physician...

In the world of healthcare, where precision and compliance are paramount, pharmacies stand as the vital link between physicians and the patients they serve. Yet, in the complex web of regulations, changing laws, and evolving industry standards, pharmacies must...