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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...

Surprise Cuts in Medicaid Reimbursements and the Impact on Independent Pharmacies

Pharmacy Benefit Managers (PBMs) use many different tactics to increase their revenue, and spread pricing has long been a common way to generate incremental revenue from each transaction. This has become a state-wide problem in Kentucky, especially for the Department for Medicaid Services (DMS). Pharmacy costs have become the fastest growing budget items in the Kentucky Medicaid budget. In the calendar year 2018, PBMs reported being paid $957.7 million from...

Pharmacy ALERT: Increased Scrutiny on PBM Credentialing Applications

Recently, Pharmacy Benefit Managers (PBMs) have been subjecting pharmacies and their credentialing applications to additional scrutiny. In one instance, a major PBM sought to terminate a pharmacy for its failure to report disciplinary action against the Pharmacist-In-Charge's license that occurred over 17 years prior. In another instance, another PBM attempted to terminate a pharmacy for allegedly not updating its ownership information. Frier Levitt was able to assist both pharmacies in...