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Pharmacy ALERT: Prime Therapeutics Heightens Investigative Efforts Against Pharmacies with Enhanced Oversight Addendums

Prime Therapeutics is notorious for taking an aggressive stance against its network pharmacies regarding enhanced credentialing criteria.  Over the past year, we have reported numerous instances whereby Prime has sought to terminate pharmacies for alleged credential non-compliance.  In recent weeks, Prime has taken steps to heighten its investigation into pharmacies that have signed Enhanced Oversight Addendums (EOA). These EOAs were offered to pharmacies participating in Prime’s networks in response to...

How to Respond to Document Requests, Audits & Overpayment Demands Webinar Recording

https://youtu.be/QY7nwgQ1IlY Healthcare is one of the most highly regulated industries in the country. When physicians and practices receive document requests, audit notices, and overpayment demands, knowing what to expect and how to react can help save money, protect your professional license and avoid litigation. This webinar will take you through the process of the what to do when you or your practice receives a request or demand from a government...

New DOJ False Claims Act Guidelines: Credit for Disclosure, Cooperation and Remediation

In May, the US Department of Justice (DOJ) issued revised guidelines regarding "taking disclosure, cooperation and remediation into account in False Claims Act (FCA) matters." These guidelines highlight the federal government’s interest in the voluntary disclosure of FCA violations by entities and individuals. The DOJ notes that "entities and individuals that make proactive, timely, and voluntary self-disclosure" to the government may be eligible to receive credit during the resolution of...

What Healthcare Providers and Pharmacies Need to Know About Government Subpoenas for Records

https://youtu.be/bPvL0Q7KYMs Attorney Daniel G. Giaquinto, Esq., discusses what physicians, pharmacies, and other healthcare providers need to know about government subpoenas and what to do when they receive one. This video covers: [00:00:36]: What is a Subpoena? [00:02:12]: Different Types of Subpoenas [00:03:05]: Government Subpoenas [00:03:50]: What Will Subpoena Contain? [00:05:07]: What to do When Receiving Subpoena [00:07:22]: Assessing a Subpoena [00:12:21]: Production Contact Frier Levitt today to speak to an...

UnitedHealthcare Wrongly Categorized Cancer Treatment as Experimental to Avoid Coverage

Recently, a class action against UnitedHealthcare was filed in the United States District Court for the Southern District of Florida. The class members in the lawsuit allege that UnitedHealth wrongly categorized proton beam radiation therapy as an experimental or investigational treatment for prostate cancer to avoid providing coverage. This suit took a drastic turn when the presiding Judge Robert N. Scola Jr. recused himself because of his personal view on...