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»  Posts By   April 2019 

24 Indicted in Telemedicine Fraud Scheme

Twenty-four individuals have been charged in a health care fraud scheme that resulted in a $1.2 billion loss to federal health care programs. The charges target those involved in a conspiracy affecting Medicare beneficiaries. Call centers were used to generate beneficiary leads, each of whom was promised free or low-cost durable medical equipment. The call centers then submitted kickbacks to telemedicine companies to facilitate the issuance of a DME order...

Plan Sponsor ALERT: New York Seeks To Eliminate PBM Spread Pricing

On April 1, 2019, New York legislators have passed new regulations eliminating "spread pricing" on prescription drugs within the Medicaid managed care system. Under "spread pricing" arrangements, PBMs bill the Plan Sponsor for the drug dispensed by the pharmacy more than the amount the PBM pays to the pharmacy. The difference is the "spread," which the PBM retains as revenue. Over the last few years, PBMs have been lowering pharmacies'...

Recent DOJ Complaint Targets Hospital’s Compensation Arrangements with Physicians

On March 25, 2019, the U.S. Department of Justice (DOJ) filed a 49-page, multi-count complaint in Pennsylvania federal court against Wheeling Hospital in West Virginia, citing the hospital’s payments to physicians as violating the Anti-Kickback Statute, Stark Law and False Claims Act (FCA). The alleged fraud scheme includes, but is not limited to, incentive compensation paid to physicians employed by the hospital and suspect equipment rental arrangements with a radiology...

Provider ALERT: Open Payments Review Period Begins April 1st

The Open Payments program collects and publishes data regarding financial relationships between the healthcare industry, including applicable drug and device manufacturers and GPOs, and healthcare providers ("Covered Recipients") on a publicly accessible website that enables consumers of health care to search, download, and evaluate the reported data. The law that gave rise to the program is commonly referred to as the Physician Payments Sunshine Act, or simply the "Sunshine Act."  ...
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