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»  Posts By   February 2016 

Senior Counsel Michelle Greenberg is Victorious in Appellate Court

Congratulations to Partner, Michelle Greenberg, Esq., on a significant appellate court victory.  25-2-9108 Roberts v. Moise, App. Div. (per curiam) (18 pp.) Plaintiff appealed the dismissal of her complaint in which she sought to establish her entitlement to a membership interest in defendant Northeast Anesthesia and Pain Management LLC. In her complaint she asserted claims for: specific performance of the employment agreement; breach of the EA; breach of the covenant...

“Lack of Medical Necessity”: An Increasingly Utilized and Amorphous Enforcement Tool

This is the first in a series of articles. As Healthcare attorneys, we begin our day reading press releases from the U.S. Department of Justice (DOJ) and Office of Inspector General in the U.S. Department of Health and Human Services (OIG). These press releases tout recent prosecutions or guilt pleas achieved against  healthcare providers by Assistant United States Attorneys. These crack-of-dawn emails serve as a daily reminder of the immeasurable...

PBMs Increase Scrutiny of Pharmacy-Manufacturer Relationships Renewing Focus on Pharmacy Compliance

Beginning late last year, pharmacy benefits managers (PBMs) broadened their crackdown on specialty pharmacies, including those that the PBMs believed had close ties to particular manufacturers. Using a variety of reasons or guises – including, as in Philidor's case, improper mail order operations – PBMs have removed several pharmacies from their networks. These actions have brought focus on certain pharmacy-manufacturer relationships, with PBMs publically declaring their targeting of "captive” pharmacies,...

Health Insurance Company Mergers: A Cause for Antitrust Concerns?

Recently, there have been two significant proposed mergers between large health insurance companies – the acquisition of Humana Inc. by Aetna Inc., and the acquisition of Cigna Corp. by Anthem Inc. Significantly, these mergers would result in 42% of the nation’s population being covered by only three insurance companies. This has led to increased antitrust concerns, with the American Medical Association, as well as several lawmakers, stating that they fear...

Oregon Pharmacists Advised to Update Their Drug Storage Policies

Effective January 1, 2016, Oregon-licensed pharmacies are expected to understand and be compliant with the regulations outlined in OAR 855-041-1036. These rules establish standards for the proper storage of all drugs, outline requirements for cold storage, and require a written quality assurance protocol for vaccines. The amended rules include provisions which require vaccines to be stored in a temperature stable section of the refrigerator as well as requiring the refrigerator...
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