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»  Posts By   January 2019 

Regardless of the Recoupment Amount, PBM Audit Appeals are Essential to Prevent Network Termination Based on Negative Audit History

Often, many pharmacies allow PBM audit findings to go uncontested due to smaller claw back amounts. Even if a PBM audit does not result in adverse action beyond the recoupment of monies from the pharmacy, PBMs keep track of their network pharmacies' audit histories. Increasingly, PBMs are using prior audit results as justification to terminate the pharmacy years later after the pharmacy has another adverse audit finding. Though the smaller...

Frier Levitt Successfully Removes Fraudulent Online Physician Reviews as Trend Continues to Grow

Frier Levitt was recently successful in removing three fraudulent online reviews for a New Jersey-based medical office. Unfortunately, in an era of digital communications, it has become extremely easy for disgruntled patients to vent by making posts about physicians and their practices on social media and online review sites. Many times, these negative reviews can contain false and even defamatory information that can be damaging to a physician’s reputation, their...

Good News for Distributors and Manufacturers: Court Holds Municipalities to Higher Pleading Standards in Lawsuits in Comparison to Claims Brought by States and the Federal Government

With lawsuits brought by municipalities against opioid manufacturers and distributors exploding across the country in nearly every state, a recent court ruling gives municipalities pause, providing both relief and clarity to the industry. Last week, the Superior Court in the Judicial District of Hartford dismissed a suit brought by Connecticut municipalities against opioid manufacturers and distributors (including Purdue Pharma, L.P., Teva Pharmaceuticals USA, Inc., Johnson & Johnson, McKesson Corporation, Cardinal...

Frier Levitt Successfully Reduces PBM Audit by $392K for New York-Based Pharmacy

A New York-based pharmacy was facing a $400k recoupment following a PBM invoice reconciliation audit where the PBM had alleged the pharmacy did not have proper inventory. This is not an uncommon occurrence as PBMs often conduct invoice reconciliation audits to compare quantities of medications and the quantities billed. After submitting invoice documentation and other supporting materials, Frier Levitt successfully demonstrated that the pharmacy had maintained sufficient inventory at all...

The District of New Jersey’s Creative Charging Greatly Increasing Physician Criminal Exposure

When dealing with white collar crime and fraud, federal sentencing guidelines largely reflect the amount of loss sustained. When it comes to the federal Anti-Kickback Statute (AKS)- which makes it a crime to seek, offer, give or receive any remuneration in exchange for the referral of a health care service- the loss is the amount of reimbursement from a federal healthcare program (Medicare, Medicaid, Tricare, etc.) for any service during...
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