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JUL
14
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Medicare Fraud Strike Force Announces $1.3 Billion Healthcare Fraud Takedown

Posted by MDRXlaw
In what is becoming an annual tradition, the Medicare Fraud Strike Force, comprised of members from the U.S. Department of Justice and the Department of Health and Human Services (more about which can be read here ), announced the latest "unprecedented" healthcare fraud takedown. The nationwide bust netted more than 412 individuals suspected of a c...
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JUL
12
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Healthcare Industry Welcomes Changes to Overtime Wage Guidance

Posted by MDRXlaw
In a step viewed optimistically by healthcare businesses, the United States Department of Labor ("DOL") has withdrawn two Obama-era guidance letters used to interpret the overtime wage provisions of the Fair Labor Standards Act. The first guidance letter concerned independent contractors, and set forth the DOL's now-former position that most worker...
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JUL
05
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Final Guidance for Part D DIR Reporting Requirements: Promising Developments for Pharmacies

Posted by MDRXlaw
It appears that the Centers for Medicare & Medicaid Services ("CMS"), in its newly-released Final Guidance on Medicare Part D DIR Reporting Requirements for 2016, has begun addressing the lack of transparency surrounding Part D plan sponsors' collection of Direct and Indirect Remuneration ("DIR") fees from independent pharmacies. DIR "clawback"...
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JUL
05
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Senators; New York Times Article Highlights Abuses by Treasury Department

Posted by MDRXlaw
Contractors Responsible for Collecting Debts Alleged against Medicare Providers   A recent New York Times article, available here , detailed abuses committed by debt collection agencies contracted by the United States Department of Treasury and its sub-agency, the I.R.S. These abuses were also the subject of a recent letter from multiple Unite...
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JUN
19
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HIPAA UPDATE: OCR RELEASES CYBER-ATTACK RESPONSE CHECKLIST

Posted by MDRXlaw
The Office of Civil Rights of the U.S. Department of Health and Human Services ("OCR") has released a checklist of actions to be taken by covered entities in the event of a ransomware attack or other cyber-related security incident. OCR noted that in investigating breaches of protected health information ("PHI"), it will consider all mitigation eff...
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JUN
16
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Supreme Court Analysis: Ruling A Victory For Biosimilar Developers

Posted by MDRXlaw
The Supreme Court handed biosimilar drug developers a clear victory this week in its decision on Amgen Inc. v. Sandoz Inc. In its decision, the high court considered the provisions of the federal Biologics Price Competition and Innovation Act of 2009 (the "Act"), specifically, the Act's requirement that biosimilar developers , prior to commercially...
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JUN
09
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The Next PBM Audit Battleground: Is Your Distributor Authorized to Sell Diabetic Supplies?

Posted by MDRXlaw
It appears that the next major challenge for independent pharmacies has been identified: the authorization, or lack thereof, of wholesalers to sell diabetic supplies purchased by the pharmacy. Less than a year ago, CVS/Caremark unilaterally amended its standard pharmacy agreement to require that pharmacies only purchase diabetic supplies from so-ca...
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JUN
02
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Express Scripts' New Surety Bond Requirement

Posted by MDRXlaw
Recently, Express Scripts started requiring that pharmacies seeking new enrollment provide a $500,000 surety bond as a condition of entering into the provider agreement. The cost of such a surety bond depends on the pharmacy and its owners' creditworthiness, but is still very high, and can easily exceed $15,000. We urge new and prospective pharmacy...
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APR
13
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Roche's Test Strips Lawsuit Targets Wholesalers, Pharmacies

Posted by MDRXlaw
On March 28, 2017, Roche Diagnostics Corp. and Roche Diabetes Care, Inc. filed a lawsuit in the U.S. District Court for the Southern District of Indiana, entitled Roche Diagnostics Corp. et al. v. Binson's Hospital Supplies, Inc., et al., ​Docket No. 17-cv-0949 (LJM)(DML). The Indianapolis-based subsidiaries of the Swiss pharmaceutical company...
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APR
03
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TOWARDS INCREASED PBM TRANSPARENCY

Posted by MDRXlaw
Is Increased PBM Transparency on the Way? Newly proposed Federal legislation would increase PBM transparency regarding aggregate rebates and "spread pricing".An oft-controversial issue, independent pharmacy associations have long lobbied for greater disclosure of the rebates that PBMs receive from drug companies, which can have a significant effect...
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APR
03
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INSURANCE PLAN NOT PERMITTED TO “CROSS-PLAN” RECOUP AGAINST PROVIDERS

Posted by MDRXlaw
A Federal District Court in Minneapolis has issued a highly favorable decision for physicians and healthcare providers on the limits of an insurance plan's ability to recoup.  Specifically, the court ruled that insurers can only recoup against providers from the same health plan that the alleged overpayment was issued under, even if the insure...
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MAR
31
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MDRXLaw 2017 Q1 Newsletter - Focus on PBM Audit Practices

Posted by MDRXlaw
We are pleased to announce the publication of our 2017 First Quarter Newsletter devoted to the issues facing pharmacies in connection with PBM audits. Please read it here.
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MAR
28
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MFCU Takes Recoupment Actions Against Providers in Connection With Percentage-Based Billing Arrangements

Posted by MDRXlaw
Calling the attention of every New York Medicaid provider reimbursing its billing/collection agents on a percentage basis, the New York State Medicaid Fraud Control Unit (MFCU) has recently sent out recoupment letters demanding repayments of Medicaid funds paid to billing companies under fee-splitting arrangements. Notably, the recoupments actions ...
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DEC
29
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MEDICARE APPEALS BACKLOG MUST BE CLEARED, RULES COURT

Posted by MDRXlaw
In a groundbreaking decision addressing one of the most pressing issues currently faced by Medicare providers, the U.S. District Court for the District of Columbia ordered CMS to clear the lengthy backlog of Medicare appeals at the administrative law judge (ALJ) level. Under the Medicare Act, CMS must provide an ALJ hearing and decision within 90 d...
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DEC
29
0

PROTECTING ACCESS TO PHI

Posted by MDRXlaw
As providers continue to rely on software vendors to maintain protected health information ("PHI"), a well-drafted business associate agreement ("BAA") becomes increasingly important. The BAA will set forth the obligations between providers and business associates such as software vendors with respect to the PHI. Software vendors will often attempt...
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JUL
15
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A GUIDE TO NY & NJ INTEGRATED CARE FACILITIES

Posted by MDRXlaw
New regulations governing integrated care are affording health care providers and facility operators a cost-effective opportunity to expand the range of treatment services they offer. As is true in the early stages of any significant regulatory shift, it is vital for providers and operators to stay aware of the complex regulatory developments that ...
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JUL
15
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AGENCY PROFILE: MEDICARE FRAUD STRIKE FORCE

Posted by MDRXlaw
This is the first article in an educational series to appear on the MDRXLaw Blog, profiling various regulatory and law enforcement agencies and entities relevant to health care providers. Given the number of agencies and entities having jurisdiction over health care providers, the individual role played by each can often be unclear. This post will ...
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JUN
28
0

Unprecedented National Health Care Fraud Crackdown

Posted by MDRXlaw
NEWS BRIEF: Unprecedented National Health Care Fraud Crackdown; 301 Individuals Charged; $900 Million in False Billing Alleged The joint DOJ-HHS Medicare Fraud Strike Force and twenty-three state Medicaid Fraud Control Units executed an unprecedented nationwide sweep earlier this week, announced as the largest health care fraud takedown in history....
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MAY
16
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U.S. ATTORNEY PROBES CONTRACTS BETWEEN DRUGMAKERS, PBMS.

Posted by MDRXlaw
According to Reuters , the U.S. Attorney's Office for the Southern District of New York is investigating links between drugmakers and companies that manage prescription benefits. In at least one instance, the U.S. Attorney is investigating contracts with, services from and payments made to PBMs in connection with certain drugs. The article notes th...
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MAR
25
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E-script Requirements Going Into Effect

Posted by Kristina Giyaur
Effective March 27, 2016, a new law will require New York State prescribers to issue prescriptions electronically directly to a pharmacy, with limited exceptions. The new law requires electronic prescribing for all types of medications (controlled substances and non-controlled substances) and for syringes and other medical devices dispensed at a ph...
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