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OCT
09
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Pharmacies are Eligible to Participate in Phase 3 of the CARES Act Provider Relief Fund

Posted by MDRXlaw
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...
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MAY
29
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Best Practices for Resuming Outpatient Elective Procedures, Post-PAUSE

Posted by MDRXlaw
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...
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MAY
20
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Pharmacy Alert: Rochester Drug Cooperative, Following Bankruptcy, Ramps up Litigation against Pharmacies

Posted by MDRXlaw
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, ...
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MAY
18
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Galderma Laboratories Lawsuits Update

Posted by MDRXlaw
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...
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APR
01
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New Guidance Regarding SBA PPP Loans

Posted by MDRXlaw
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 ...
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MAR
26
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COVID-19 Employment Law Q&As

Posted by MDRXlaw
​ 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...
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MAR
24
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GOV. CUOMO, DOH COMMISSIONER ORDER FACILITIES TO INCREASE BED AVAILABILITY FOR COVID-19 PATIENTS

Posted by MDRXlaw
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...
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MAR
18
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CONGRESS AND HHS ANNOUNCE SIGNIFICANT EXPANSIONS TO MEDICARE TELEHEALTH COVERAGE IN RESPONSE TO CORONAVIRUS

Posted by MDRXlaw
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...
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MAR
17
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CORONAVIRUS EMERGENCY MEASURES: WAIVER OF STATE LICENSURE REQUIREMENTS, OTHER POLICIES GOING INTO EFFECT

Posted by MDRXlaw
  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...
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MAR
17
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Telemedicine and COVID-19: Medicare to Reimburse Practitioners Treating Patients at Home

Posted by MDRXlaw
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...
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MAR
17
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Laboratory Testing and Billing for COVID-19

Posted by MDRXlaw
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...
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NOV
06
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Opioid Litigation Update: Invasive Subpoenas Issued to Pharmacies; Information Regarding RDC Sought

Posted by MDRXlaw
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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AUG
21
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Important Client Alert - OptumRx Provider Manual Update

Posted by MDRXlaw
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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JUL
22
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Sauchik & Giyaur, P.C. secures reversal of network termination of five providers

Posted by MDRXlaw
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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APR
19
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PharmacyFirst's Participants Are Hit With GER Clawbacks

Posted by MDRXlaw
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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APR
10
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Alec Sauchik selected to join the Health Law Committee of NYCBA

Posted by MDRXlaw
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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APR
03
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Visit us in Vegas!

Posted by MDRXlaw
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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JAN
18
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Medicaid Providers, Beware: OMIG Places Provider Compliance Programs Under Review

Posted by MDRXlaw
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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NOV
02
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The SUPPORT Act - Providers Need to Take Notice

Posted by MDRXlaw
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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OCT
24
0

The Importance of Fresh Perspectives When Challenging PBM Audit Findings and Termination Notices

Posted by MDRXlaw
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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