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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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  2110 Hits
2110 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.
  2868 Hits
2868 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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  2345 Hits
2345 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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  1855 Hits
1855 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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  1831 Hits
1831 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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  2527 Hits
2527 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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  3307 Hits
3307 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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  2708 Hits
2708 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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  2870 Hits
2870 Hits
MAY
16
0

PAYING OVERTIME WAGES TO PROFESSIONAL EMPLOYEES

Medical practices, urgent care centers, and other healthcare facilities often employ clinical practitioners, such as physician assistants or nurse practitioners, who frequently work over 40 hours per week.   Whether these employees need to be paid overtime wages is a question our clients frequently ask us in our role as employme...
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  2675 Hits
2675 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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  2536 Hits
2536 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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  3979 Hits
3979 Hits
JAN
28
0

Abbott Issues a New Round of Subpoenas to Many Pharmacies

​Pharmacies and pharmacists across the country are receiving subpoenas in a federal case filed in the Eastern District of New York.  In this case, a manufacturer of diabetic test strips, Abbott  Laboratories, is suing distributors and pharmacies accusing them of importing and selling diabetic test strips intended for sale i...
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  4521 Hits
4521 Hits
JAN
07
0

Medicare Appeals - New Developments, Old Delays

Office of Medicare Hearings and Appeals (OMHA) recently created a new website to facilitate monitoring of ALJ appeals. Physicians, DME suppliers & other providers can now check on the status of filed Medicare reimbursement appeals, find useful documentation as well as other information pertinent to the appeal. OMHA also launched listserv websit...
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  3424 Hits
3424 Hits
JAN
06
0

MDRXLaw sponsors the NY Chapter of the ACHE

MDRXLaw is proud to announce its sponsorship of the Healthcare Leaders of New York , the New York chapter of the American College of Healthcare Executives . HLNY represents professionals who manage the business affairs of healthcare organizations throughout the New York Metropolitan area. No other professional association is more essential for meet...
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  3734 Hits
3734 Hits
NOV
24
0

MEANINGFUL USE AUDIT: HOW CAN A PRACTICE PREPARE?

While the stated goals of meaningful use compliance include terms such as empowerment, improvement and efficiency, for many participating physicians the possibility of a meaningful use audit just adds another level of anxiety to the already stressful and increasingly time-consuming burden of administrating a medical practice in the current regulato...
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  2781 Hits
2781 Hits
NOV
24
0

THE INDEPENDENT PHARMACY’S GUIDE TO SURVIVING A PBM AUDIT

Nothing is as critical to the economic health of an independent pharmacy as successfully resolving inevitable audits by Pharmacy Benefits Managers ("PBMs"). While the PBM concept originated as a measure to cut back on fraud, waste and abuse, the current role played by a PBM can often be perceived as antagonistic to the interests of independent phar...
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  4508 Hits
4508 Hits
OCT
06
0

NEW YORK PHYSICIANS COMPLIANCE PROGRAM MANDATE

The New York State Office of Medicaid Inspector General ("OMIG") has long required Medicaid providers to implement compliance programs as a condition of enrollment with Medicaid. However, now under Federal law, practitioners, regardless of the size of their practice, will have to develop a comprehensive compliance program. Under Section 6401 of the...
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  3244 Hits
3244 Hits
SEP
30
0

We Are Selected to SuperLawyers 2016

For the third year in a row, Kristina Giyaur and Alec Sauchik have been selected to the prestigious list of attorneys - SuperLawyers Rising Stars in Healthcare Law.  Super Lawyers is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievemen...
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  3112 Hits
3112 Hits