Call Us: (212) 668-0200

NEWS AND PUBLICATIONS

  1. Home
  2. NEWS AND PUBLICATIONS
  3. News and Updates

News and Updates

 
JAN
18
0

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...
Continue reading
0
  231 Hits
Tweet
231 Hits
NOV
02
0

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...
Continue reading
0
  515 Hits
Tweet
515 Hits
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...
Continue reading
0
  543 Hits
Tweet
543 Hits
OCT
16
0

A New Jersey Pharmacy Owner Charged With “Cash Skimming” Conspiracy – Is Your Pharmacy at Risk?

Posted by MDRXlaw
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...
Continue reading
0
  790 Hits
Tweet
790 Hits
OCT
16
0

Importance of Addressing Third-Party Audits Properly

Posted by MDRXlaw
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...
Continue reading
0
  428 Hits
Tweet
428 Hits
OCT
16
0

Medicare Appeals Backlog – Light at the End of the Tunnel?

Posted by MDRXlaw
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...
Continue reading
0
  372 Hits
Tweet
372 Hits
OCT
16
0

Merger Mania: Exploring the Impact of ESI/Cigna and CVS/Aetna Mergers on Independent Pharmacies

Posted by MDRXlaw
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...
Continue reading
0
  433 Hits
Tweet
433 Hits
SEP
23
0

DOJ APPROVES CIGNA-EXPRESS SCRIPTS MERGER

Posted by MDRXlaw
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...
Continue reading
0
  476 Hits
Tweet
476 Hits
SEP
04
0

HHS Echoes Importance of HIPAA Compliance for Closed Businesses

Posted by MDRXlaw
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...
Continue reading
0
  602 Hits
Tweet
602 Hits
SEP
04
0

CMS Updates Final Adverse Actions to Be Reported

Posted by MDRXlaw
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...
Continue reading
0
  585 Hits
Tweet
585 Hits
AUG
18
0

Physical Therapy Practices are Growing – But Also Face Increased Challenges

Posted by MDRXlaw
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 ...
Continue reading
0
  754 Hits
Tweet
754 Hits
AUG
16
0

Compounding Pharmacies Under Scrutiny for Medicare Part D Billing Practices

Posted by MDRXlaw
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...
Continue reading
0
  663 Hits
Tweet
663 Hits
JUL
19
0

Can a Physician’s Medical Judgment be Basis for a False Claims Action? Appellate Court Rules Yes.

Posted by MDRXlaw
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 ,...
Continue reading
0
  788 Hits
Tweet
788 Hits
JUL
02
0

Nationwide Crackdown Charges 601 Individuals with Over $2 Billion in Healthcare Fraud

Posted by MDRXlaw
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, numerous healthcare providers were charged with over a combined $163 million in healthcare fraud. The Medicare...
Continue reading
0
  921 Hits
Tweet
921 Hits
JUN
25
0

New Jersey Act Imposes New Requirements to Protect Consumers

Posted by MDRXlaw
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 healthcare charges.Health care facilities and professionals must ensure their compliance with these new requ...
Continue reading
0
  660 Hits
Tweet
660 Hits
JUN
08
0

New York State Takes Action Against Abusive PBM Audits, Grants New Protections to Independent Pharmacies

Posted by MDRXlaw
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 purchase invoices from a broader range of wholesalers and distributors.  This provision is notable as PBMs...
Continue reading
0
  881 Hits
Tweet
881 Hits
JUN
04
0

What NYC Employers Must Know About the Safe Leave Law

Posted by MDRXlaw
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 amendments to the Act, which are presently going into effect, allow employees to use paid leave not only for s...
Continue reading
0
  966 Hits
Tweet
966 Hits
JUN
04
0

New York State Imposes Limitations on LHCSA Applications

Posted by MDRXlaw
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 of LHCSA applications, subject to certain exceptions. Presently, the exceptions include applications for ALP-Related ...
Continue reading
0
  650 Hits
Tweet
650 Hits
NOV
29
0

The Rising Cost of Employing Excluded Individuals

Posted by MDRXlaw
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 individuals have risen sharply. "Excluded individuals" are parties excluded from Federally-funded healthcare progra...
Continue reading
0
  1781 Hits
Tweet
1781 Hits
NOV
15
0

Under the Travel Act, Aggressive Federal Enforcement Against Providers Expands

Posted by MDRXlaw
Q.  When does a purely state criminal law-based matter transform into a federal felony prosecution? A.  When the Federal Travel Act (the "Travel Act") is implicated.Under the Act, a party who travels in interstate commerce or uses the mail or any facility in interstate commerce, with intent to promote or carry on "unlawful activities...
Continue reading
0
  1536 Hits
Tweet
1536 Hits
    Previous    
1 2 3

Categories

CLIENT ALERTS
CLIENT ALERTS
4 post(s)
Pharmacy Law
Pharmacy Law
8 post(s)
Compliance
Compliance
14 post(s)
Fraud and Abuse
Fraud and Abuse
9 post(s)
News and Updates
News and Updates
46 post(s)

Archive

© 2019 Sauchik & Giyaur, P.C. All Rights Reserved

DISCLAIMER  |  PRIVACY POLICY  |  ATTORNEY ADVERTISING