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»  Posts By   February 2017 

PHARMACY ALERT: Roche Begins Issuing Demand Letters Seeking Repayment for Test Strips Claims

Pharmacies have begun receiving demand letters from Roche Diagnostics Corp. and Roche Diabetes Care, Inc. ("Roche'') for repayment of money as it relates to claims for vials/boxes of Roche Accu-Chek blood-glucose test strips. Roche states that, based on data gathered from rebate claims submitted by insurers, pharmacies received reimbursement for test strips intended for retail sale while actually dispensing discounted products, including test strips that are marked as Durable Medical...

ACP Releases Revised Guidelines for the Prescribing of Opioids for Chronic Back Pain

On Monday February 13th, the American College of Physicians (ACP) published updated clinical guidelines relating to chronic low back pain, revising its previous recommendations to suggest that practitioners opt for noninvasive treatments rather than a defaulting to the use of medication as a first line of therapy. The ACP conducted various trials and reviews targeting adults with acute, subacute or chronic low back pain and  recommended generally that clinicians should...

“Reverse” False Claims Act Actions Against Providers Are On the Rise

Delaying the Return of Overpayments to the Government Could Cost You Millions Recent statutory reforms have given rise to a new and increasingly-common form of liability under the False Claims Act (FCA) – so-called "reverse" FCA liability. Specifically, the Fraud Enforcement and Recovery Act of 2009 (FERA) modified the FCA such that it is now a violation of the statute to "knowingly" conceal or avoid repaying an "obligation to pay...

What You Need to Know About the Medicare Appeals Process

One: Administrative Law is extremely complex and difficult to navigate Medicare rules in general, and the appeals process in particular, are codified in a complex body of regulations known as administrative law. However, many healthcare providers rely on non-lawyers, typically billing professionals, to file their Medicare appeals. This approach to tackling appeals often creates substantial risks for many providers, as the foundation of any successful appeal is a thorough understanding...

HHS withdraws 340B Mega Guidance

On January 30, 2017, the United States Department of Health and Human Services (HHS) decided to withdraw "Mega Guidance" related to the 340B drug discount program. This withdrawal comes after the Trump administration put a freeze on new regulations. The 340B drug discount program is a United States federal government program that requires drug manufacturers participating in Medicaid to provide outpatient drugs to eligible health care organizations, known as covered...
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