Blog

»  Posts By   March 2014 

PBMs Dramatically Increase Their Audit Focus on Copayment Collection. Is Your Pharmacy Prepared?

Over the past few weeks, multiple Pharmacy Benefits Managers (PBMs) have been dramatically increasing their focus on a pharmacy’s collection of copayments or other patient pay amounts from the PBMs’ patients. Express Scripts, Caremark and MedImpact are just some of the PBMs who have stepped up their focus on participating pharmacy’s copayment collection practices, and their ability to document the collection of copayments. The PBM manuals generally prohibit the waiver...

Doctors Investing in Real Estate: Good Medicine for the Portfolio?

Despite worried forecasts for the start of the new millennium, the economy was strong.  As stock prices began to fall in the early 2000s, however, investors began looking for options to further diversify their portfolios. Commercial and residential real estate became popular for those with extra disposable income, such as doctors, and people who had never purchased these types of assets for investment discovered exciting opportunities. The subsequent downturn of...

Potential Bill Would Dramatically Modify In-Office Ancillary Services Exception to Stark Law

Physicians who currently perform pathology services, radiation therapy and services, advanced diagnostic imaging studies, and physical therapy services in their offices should be aware of a new bill that was introduced in August 2013: H.R. 2914, entitled the “Promoting Integrity in Medicare Act of 2013” (PIMA). The bill would majorly curtail the ability to offer several services in-office, and prohibit many common, currently legal arrangements. At present, the federal physician...

Federal Government Settles First Case of Potential HIPAA Violations with a County Government

Skagit County, Washington, has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Skagit County agreed to a $215,000 settlement, also agreeing to correct deficiencies in its HIPAA compliance program. "This case marks the first settlement with a county government and sends a strong message about the importance of HIPAA compliance to local and county governments, regardless of size," said Susan McAndrew, deputy...

Thanks to Tort Reform, Whistleblower Claims on the Rise Against Healthcare Providers

Last week, yet another pharmaceutical company entered into a settlement agreement with the Department of Justice, agreeing to pay $193 million to settle whistleblower claims that it marketed Lidoderm (a shingles drug) for purposes not approved by the FDA. This marks a continued trend of the U.S. government in pursuing healthcare companies for False Claims Act violations, having recovered over $3.8 billion in 2013.  However, this recent case involving the...