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Compound Pharmacy Owner Pleads Guilty to Health Care Fraud In Connection With Kickbacks Paid by Pharmacy Representative to Physicians in Exchanges for Referrals of Prescriptions for Topical Pain Creams

Last month, an owner of a New Jersey compounding pharmacy pled guilty to paying tens of thousands of dollars in cash bribes to physicians in exchange for referrals of pain cream prescriptions, defrauding health care benefit programs out of hundreds of thousands of dollars. It is alleged that for approximately one year, the pharmacy owner had been utilizing and paying a pharmacy representative, who in turn, had been paying a...

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,...