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JUL
12
0

Healthcare Industry Welcomes Changes to Overtime Wage Guidance

In a step viewed optimistically by healthcare businesses, the United States Department of Labor ("DOL") has withdrawn two Obama-era guidance letters used to interpret the overtime wage provisions of the Fair Labor Standards Act.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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  2367 Hits
2367 Hits
JUL
05
0

Final Guidance for Part D DIR Reporting Requirements: Promising Developments for Pharmacies

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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  2173 Hits
2173 Hits
JUL
05
0

Senators; New York Times Article Highlights Abuses by Treasury Department

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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  2062 Hits
2062 Hits
JUN
19
0

HIPAA UPDATE: OCR RELEASES CYBER-ATTACK RESPONSE CHECKLIST

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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  2129 Hits
2129 Hits
JUN
16
0

Supreme Court Analysis: Ruling A Victory For Biosimilar Developers

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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  1685 Hits
1685 Hits
JUN
09
0

The Next PBM Audit Battleground: Is Your Distributor Authorized to Sell Diabetic Supplies?

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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  2326 Hits
2326 Hits
JUN
02
0

Express Scripts' New Surety Bond Requirement

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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  3008 Hits
3008 Hits
APR
13
0

Roche's Test Strips Lawsuit Targets Wholesalers, Pharmacies

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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  2839 Hits
2839 Hits
APR
03
0

TOWARDS INCREASED PBM TRANSPARENCY

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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  2508 Hits
2508 Hits
APR
03
0

INSURANCE PLAN NOT PERMITTED TO “CROSS-PLAN” RECOUP AGAINST PROVIDERS

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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  2354 Hits
2354 Hits
MAR
31
0

MDRXLaw 2017 Q1 Newsletter - Focus on PBM Audit Practices

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.
  3307 Hits
3307 Hits
MAR
28
0

MFCU Takes Recoupment Actions Against Providers in Connection With Percentage-Based Billing Arrangements

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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  2600 Hits
2600 Hits
DEC
29
0

MEDICARE APPEALS BACKLOG MUST BE CLEARED, RULES COURT

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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  2027 Hits
2027 Hits
DEC
29
0

PROTECTING ACCESS TO PHI

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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  1990 Hits
1990 Hits
JUL
15
0

A GUIDE TO NY & NJ INTEGRATED CARE FACILITIES

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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  2685 Hits
2685 Hits
JUL
15
0

AGENCY PROFILE: MEDICARE FRAUD STRIKE FORCE

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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  3540 Hits
3540 Hits
JUN
28
0

Unprecedented National Health Care Fraud Crackdown

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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  2925 Hits
2925 Hits
MAY
16
0

U.S. ATTORNEY PROBES CONTRACTS BETWEEN DRUGMAKERS, PBMS.

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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  3095 Hits
3095 Hits
MAR
25
0

E-script Requirements Going Into Effect

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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  2734 Hits
2734 Hits
FEB
26
0

Firm Represents a Co-Op in Sandy-Related HPD Grant

The firm has successfully completed its representation of a 157-unit co-op corporation in southern Brooklyn, which was severely damaged during Hurricane Sandy, in connection with closing on an HPD Build-It-Back recovery grant.  The effort led by Alec Sauchik, Esq. culminated in the HPD reimbursing the building for past expe...
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  4192 Hits
4192 Hits