Blog

»  Posts By   October 2013 

Pharmacy Payment to Marketers Based on Number of Patients leads to Civil and Criminal Settlement

The US Department of Justice reached a settlement with a Kansas-based supplier of mail-order diabetic supplies to resolve allegations of submission of false claims to federal healthcare programs. The settlement requires that the defendants pay a total of $13-million to federal government. The US attorney alleged that the individual owners of Global Medical, Inc. entered into numerous marketing contracts with insurance brokerage and other companies with customer bases likely to...

House Passes Stricter Regulations for Compound Pharmacies

Approximately one year removed from the Meningitis tragedy caused by Framingham-based compounder, New England Compounding Center, the Massachusetts House of Representatives has unanimously voted to pass a Bill that requires stricter regulation of compound pharmacies. Some of the new regulations include unannounced inspections of compounders, new reporting requirements, whistleblower protections, additional labeling requirements, continuing education classes for sterile compounders, and increased communication between State and federal regulators regarding any "adverse...

Federal Government Issues Guidance on Refill Reminders Under New HIPAA Omnibus Rule

All covered entities (“Covered Entities”), including pharmacies must comply with changes to HIPAA enacted on January 17, 2013. Health and Human Services (“HHS”) issued a final rule (the “Final Rule”) implementing some of the most sweeping changes to HIPAA since its inception in the 1990’s with most of the provisions taking effect on September 23, 2013.   One of the changes to HIPAA enacted in the Final Rule involves significantly...

Are PBMs Holding the “Unclaimed Funds” of Your Pharmacy?

More often than you may realize, reimbursement checks are lost, destroyed or otherwise not deposited by your pharmacy. Claims reconciliation is complex and your pharmacy may be unaware of "unclaimed funds". PBMs could be holding "unclaimed funds" belonging to your pharmacy. As your attorneys, we can discover whether any Pharmacy Benefits Managers (PBM) is holding your pharmacy's reimbursement and have the un-deposited checks re-sent to you. You should find out...