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NOV
06
0

Opioid Litigation Update: Invasive Subpoenas Issued to Pharmacies; Information Regarding RDC Sought

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...
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  97 Hits
97 Hits
AUG
21
0

Important Client Alert - OptumRx Provider Manual Update

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...
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  1300 Hits
1300 Hits
JUL
22
0

Sauchik & Giyaur, P.C. secures reversal of network termination of five providers

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...
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  354 Hits
354 Hits
APR
19
0

PharmacyFirst's Participants Are Hit With GER Clawbacks

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...
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  730 Hits
730 Hits
APR
10
0

Alec Sauchik selected to join the Health Law Committee of NYCBA

Alec Sauchik, Esq. has been selected to serve on the Health Law Committee of the New York City Bar Association for the 2019-2022 term.  The Health Law Committee is comprised of attorneys of highly varied backgrounds who bring a unique perspective to health law and healthcare-related issues.  As part of his tenure, Mr. Sauchik wi...
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  546 Hits
546 Hits
APR
03
0

Visit us in Vegas!

Wynn Hotel and Resort Las Vegas, NV We will be highlighting our services and expertise at the Asembia Specialty Pharmacy Summit 2019 . Please join our attorneys and staff at the largest summit of specialty pharmacy senior executives, key decision makers and industry leaders. Visit us at Booth No. 722 or schedule a meeting with us by filling out the...
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  673 Hits
673 Hits
JAN
18
0

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 under review. Providers should take immediate action to avoid the prospect of serious sanctions, including but...
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  783 Hits
783 Hits
NOV
02
0

The SUPPORT Act - Providers Need to Take Notice

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 SUPPORT Act is available here . The SUPPORT Act will have a far-reaching impact on all healthcare providers and establish ma...
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  1096 Hits
1096 Hits
OCT
24
0

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 having a different perspective on what has taken place or what can be done to remedy the situation.  Whe...
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  1119 Hits
1119 Hits
OCT
16
0

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, his relative, and the pharmacist co-owner conspired to conceal cash income of pharmacies and did not report...
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  1264 Hits
1264 Hits
OCT
16
0

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 found can be subject to adjustments of thousands of dollars. Suspected misconduct has recently led to refer...
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  955 Hits
955 Hits
OCT
16
0

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 by 2020 if no change is made.  The appeals process, as of now, takes at least three to four years, duri...
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  826 Hits
826 Hits
OCT
16
0

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) and Aetna.  Both mergers marked major milestones. ESI was the last standalone major PBM, while the CVS...
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  1015 Hits
1015 Hits
SEP
23
0

DOJ APPROVES CIGNA-EXPRESS SCRIPTS MERGER

This is the time for independent pharmacies to be actively preparing for the impact of the Cigna-ESI merger—and the ensuing Aetna-Caremark merger—if they have not already done so. The Antitrust Division of the U.S. Department of Justice has approved the proposed Cigna-Express Scripts merger, clearing a significant obstacle to Cigna's acquisition of...
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  940 Hits
940 Hits
SEP
04
0

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, providers working with associates who shut down operations or went bankrupt are equally liable for HIPAA vio...
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  1225 Hits
1225 Hits
SEP
04
0

CMS Updates Final Adverse Actions to Be Reported

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 of Medicare enrollment in an effort to reduce provi...
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  1006 Hits
1006 Hits
AUG
18
0

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 practices. Over a decade later, private practice is still thriving in the industry.  As patient volume ...
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  1288 Hits
1288 Hits
AUG
16
0

Compounding Pharmacies Under Scrutiny for Medicare Part D Billing Practices

OIG calls for "further scrutiny" of pharmacies and prescribers in connection with compounded drugs billed to Medicare Part D.   Pharmacies must be prepared to aggressively defend against this latest attack on the independent retail pharmacy industry. An explosive new report calls for "further scrutiny" of hundreds of pharmacies and prescr...
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  1232 Hits
1232 Hits
JUL
19
0

New York Court Decision Demonstrates Importance of Proper Audit Response

It is of utmost importance that Medicaid providers take prompt measures when under audit to avoid such consequences. Recently, the New York Court of Appeals upheld a recoupment of funds by the NYS Office of the Medicaid Inspector General ("OMIG") against a provider, rejecting the provider's claim that it was not sufficiently notified of the recoupm...
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  1204 Hits
1204 Hits
JUL
19
0

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. In a recent decision, United States ex rel. Polukoff v. St. Mark's Hospital ,...
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  1344 Hits
1344 Hits