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»  Posts By   July 2020 

PHARMACY ALERT: New Medicare Part D Claim Recoupment By PBMs

While the majority of independent pharmacies have continued to see their margins shrink because of below market pricing and self-serving tactics implemented by Pharmacy Benefit Managers (“PBMs”) that only benefit themselves, Frier Levitt recently identified a new type of reimbursement issue that has impacted independent pharmacies across the country.  Specifically, a national Pharmacy Benefit Manager (“PBM”) informed its network pharmacies – only when the pharmacies made inquiries to the PBM...

Telehealth Gets Increasing Support for Federal and State Expansion

Earlier this month, the Congressional Telehealth Caucus introduced the Protecting Access to Post-COVID-19 Telehealth Act of 2020 (“Act”). This bipartisan bill will continue the current, temporary expanded use of telehealth beyond the COVID-19 pandemic by eliminating limitations that restrict its use for Medicare beneficiaries. In particular, the Act will (i) eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establish a patient’s home as...

Combatting COVID-19 Fraud

In March 2020, the Department of Justice announced a shift in focus from prosecuting typical healthcare fraud matters to fraud related to the COVID-19 Pandemic. As an illustration of this initiative, the DOJ has established a National Center for Disaster Fraud (NCDF) Hotline and a NCDF Form to report COVID-19-related fraud. Particular focus areas for DOJ include: Price gouging and hoarding of critical supplies; Antibody testing fraud schemes; Unsolicited emails...

Dental Provider Alert – Deadline Approaching for Dentists to Apply for HHS Relief Funds

The U.S. Department of Health and Human Services (“HHS”) recently announced that dentists may now apply to receive funding through the CARES Act Provider Relief Fund.  The original published deadline for applications to be submitted through the Enhanced Provider Relief Fund Payment Attestation Portal was July 24, 2020, but HHS confirmed that the deadline has been extended to Monday, August 3, 2020.  Payment for dental providers will be calculated based upon...

Provider Alert: CMS Announces Plans to Resume Provider Audits August 3, 2020

On March 30, 2020, the Centers for Medicare & Medicaid Services (“CMS”) suspended most Medicare Fee-For-Service medical reviews because of the COVID-19 pandemic. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (“MACs”) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (“SMRC”) reviews and Recovery Audit Contractor (“RAC”).  For providers whose practices were adversely impacted by the public health...