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»  Posts By   January 2017 

New Auditing Trend Highlights Need to Verify Exclusion Status of Prescribers

A new auditing trend has emerged among some PBMs (including CVS Caremark) focusing on the "exclusion" status of prescribers that have written prescriptions filled by the pharmacy. In recent audits, CVS Caremark has examined pharmacies' dispensing histories and scrutinized claims dispensed by the pharmacy that had been written by a prescriber that seemed to appear on the OIG's Excluded Provider List. The OIG's Excluded Provider List – or List of...

What Providers Need to Know About Prescribing Opioids for Pain Management

Over the last several years, the United States has seen a growing rate of opioid abuse and addiction especially in patients in need of chronic pain management, bringing the issue of proper pain management to the forefront of regulatory agendas. Health-policymakers, health professionals, and regulators are working endlessly to address the need for better pain therapy and guidance surrounding the use of opioids in treatment of chronic or recurrent pain management...

Opioid Prescribing and the Importance of Knowing Naloxone Dispensing Laws

In 2016, the Centers for Disease Control and Prevention (CDC) announced that the United States is in the midst of an opioid overdose epidemic. Opioids include both prescription drugs, such as Hydrocodone, Morphine, Percocet, and Oxycontin, and illegal drugs such as, Heroin. Both prescription opioids and heroin killed more than 33,000 people in 2015, which was more than any year on record. Although street-drugs are considered by the general public...

OIG Issues Final Rule Expanding its Exclusion Authority

On January 11, 2017, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published its Final Rule (the "Final Rule") establishing new standards for excluding individuals and entities from participation in federal health care programs. The issuance of the Final Rule reflects changes to the OIG's exclusion authorities made by the Medicare Modernization Act in 2003, and the Affordable Care Act in 2010 as well as...

Why Accounting Firms Need HIPAA Compliance Plans

It has been over two decades since the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA or Act), but only in the past six years have enforcement actions demonstrated the fervor with which the government intends to compel compliance. With trends leaning toward a continued increase in enforcement activities, entities governed by HIPAA must be aware of their duties under the Act. Prior to 2009, HIPAA...