NEWS AND PUBLICATIONS

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 practices, home care agencies, providers of behavioral health services, physician groups, and M...

Early in the COVID-19 pandemic, we saw exponential growth in the usage of telehealth. In fact, early growth of the industry displayed a 78X increase in the utilization of telehealth services verses the traditional, in-person office visits. As of July 2022, the utilization of telehealth has stabilized at levels 38X higher than before the pandemic, d...

In November 2021, for the first time, a Federal District Court in Texas held that wage fixing agreements were a per se violation of the Sherman Act that can be prosecuted criminally. The DOJ charged two employees at a Texas based staffing firm, for physical therapists and physical therapist assistants, with criminal wage fixing and conspiracy with ...

  2022 is here, and brings welcome news for independent pharmacies: New York State Governor Kathy Hochul has signed landmark legislation providing for oversight of pharmacy benefit managers, described as being "the most comprehensive regulatory framework in the country for Pharmacy Benefit Managers. "The new law should significantly benefit in...

Collection of copayments has traditionally been one of the more difficult aspects of pharmacy practice. Indeed, collection of copayments has become more difficult in recent years, as health insurers have steadily increased copayment amounts as part of the low-premium, high patient cost-sharing model. This has resulted in an increase of patients who...

In some welcome news for providers, the U.S. Department of Health and Human Services has announced the commencement of the application period for the "Phase 3" distribution from the CARES Act Provider Relief Fund. As a health care provider, here is what you need to know: Purpose: to provide funding to providers who have lost revenues and/or increas...

New York State-based Ambulatory Surgery Centers, Office-Based Surgery Practices, and Diagnostic & Treatment Centers, following a pause of two months and counting, are eager to resume elective and non-essential procedures. Before doing so, it is important to address several key considerations, as well as have strong policies and protocols in pla...

The demise of Rochester Drug Cooperative ("RDC") continues, and this time it is retail pharmacies that must beware of the fallout. In March 2020—following numerous private, state and federal government-led lawsuits accusing RDC of being complicit in the opioid crisis—RDC filed for bankruptcy and sought to wind down its operations. As part of this, ...

Many pharmacies across the United States have received demand letters from Galderma Laboratories demanding return of funds paid in connection with the CareConnect Program.  Numerous suits have been filed in the Federal District Court for the Northern District of Texas.  Attorneys at Sauchik & Giyaur, P.C. are ready to assist...

The US Department of Treasury has released new guidance regarding SBA loans to be made under the Payroll Protection Program. Some critical points clarified by the Treasury guidance include: PPP loan applications will be submitted directly to SBA-certified lenders, who can begin accepting applications as of April 3, 2020 (April 10th for independent ...

​ Q.   As a New York State employer, what paid sick leave or family leave laws are currently applicable to my business? ​A.  New York State employers are currently/will shortly be subject to: The Families First Coronavirus Response Act (federal law passed in response to COVID-19 crisis) New York State Paid Family Leave law (passed in...

Governor Andrew M. Cuomo and NYS Department of Health Commissioner Howard A. Zucker have ordered all medical facilities located in New York State— i.e. hospitals, ambulatory surgery centers, office-based surgery practices, and diagnostic & treatment centers—to take certain measures aimed at increasing bed capacity for COVID-19 patients. An offi...

Congress recently passed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which the President signed into law. In an effort to encourage social distancing and increase access to care, the law significantly expands Medicare coverage for telehealth services. Specifically, Medicare will now cover nearly all telehealth service...

  Federal and state governments are racing to implement emergency measures designed at containing and treating COVID-19. One such measure is the waiver of in-state licensure requirements for providers licensed in another state or jurisdiction. Presently, New York and New Jersey have not implemented such a measure, but approximately ten other s...

To encourage patients to seek medical attention from their homes rather than visiting a hospital or doctor's office ,  the Center for Medicaid & Medicare Services (CMS) will start reimburs ing  physicians and non-physician practitioners for "virtual check-ins" -- brief, virtual services with your established provider where the communi...

Lab s performing diagnostic tests for the 2019-Novel Coronavirus ( COVID-19 ) have new HCPCS and CPT c odes for  bill ing and track ing new cases of the virus . T he Center for Medicaid and Medicare Services (CMS) has  updated the ir  standardized coding system , which Medicare and other health insurers use to submit claims for servi...

The New York State opioid litigation, led by private plaintiffs and the Office of the Attorney General of the State of New York, has taken another turn.Plaintiffs' counsel has now issued subpoenas to thousands of New York State-based pharmacies who are not parties to the litigation.These subpoenas demand a wide range of documents and information pe...

IMPORTANT CLIENT ALERT The latest edition of OptumRx (ORX) Provider Manual (2019 4 th Edition) contains significant new provisions pertaining to maintenance of records by pharmacies.We expect that, in connection with desktop audits, ORX may start demanding documentation additional to that routinely reviewed in the past and may potentially decline t...

Sauchik & Giyaur, P.C. (the "Firm") recently secured reversal of network terminations for five providers, ensuring that the providers continued as participating providers. The individual providers, who were part of the same practice, had received abrupt network termination notices from a prominent insurance plan. The Firm, on behalf of the prov...

Pharmacies are urged to take immediate steps to challenge PharmacyFirst's actions in connection with so-called "GER" adjustments. GER ("Generic Effective Rate") provisions were added in the past year to agreements between Caremark and PSAOs, including PharmacyFirst (formerly, Third Party Station). GER is thought to be the commercial plan equivalent...