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»  Posts By   October 2014 

The Federal Government has Issued a Notice of Proposed Rulemaking Related to Safe Harbors to the Anti-Kickback Statute

On October 2, 2014, the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) proposed several rule changes to the Federal Anti-Kickback Statute that would revise certain safe harbors as well as the civil monetary penalty (CMP) rules, offering greater protection against criminal prosecution and civil sanctions for certain payment practices and business arrangements. Referral Services The first proposed change is a technical correction, which the...

Specialty Pharmacy: Pitfalls when Helping Physician Offices With Prior Authorizations

A joint federal and state investigation, stemming from a whistleblower complaint, has recently resolved resulting in a $10 million civil fine for a New York specialty pharmacy for submitting false information to obtain prior authorization for specialty medications, among other alleged fraudulent activity. Some insurance companies require a prior authorization before covering certain medication. Some medications that require prior authorizations include: Specialty or high-cost medications Brand name medicines that have...

Restricted Pharmacy Networks Increase Costs to Health Care System and Patients

Independent Specialty Pharmacies (SPs) face a multitude of headwinds. Some drugs they want to purchase are “limited distribution drugs” (LDDs), meaning the manufacturer or wholesaler will not sell to the independent pharmacy because of deals with PBMs. PBMs control and decide which independent pharmacies, if any, get admitted into pharmacy networks. Most PBMs own their own specialty pharmacies, and have an economic incentive to exclude independent SPs that present legitimate...

Resurgence of the House Call

Nowadays, it seems as though everything, from grocery shopping to banking, can be done online, and it appears that the practice of medicine is the next field poised for redevelopment by way of digital technology. Several new web and mobile device applications have recently been developed, launching location-based platforms for physician house call services. These services are predicated on convenience, and connect physicians and patients instantaneously and in real time,...

Are Insurance Carriers In Trouble? Why Should You Care?

As the Affordable Care Act (ACA) continues to influence and change the healthcare landscape, innovation in the method of delivery of healthcare is at the forefront of the shifting dynamic between healthcare providers, insurance carriers and patients. The ACA has paved the way for healthcare systems to expand their roles beyond simply providing healthcare to patients, and one manner in which this is occurring is the development of self-funded insurance...
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