Blog

Frier Levitt Saves Texas-Based Pharmacy over $1.6 Million in PBM Audit

Frier Levitt successfully saved over $1.6 Million for an independent pharmacy located in Texas against a desktop-audit conducted by a major Pharmacy Benefit Manager (PBM). The PBM claimed several different discrepancies, including inventory shortfalls, missing prescriptions, and failure to collect copays. The total amount of chargeback based on the alleged discrepancies was approximately $1.9 Million. Attorney Dae Y. Lee, Pharm.D., Esq., CPBS, conducted an extensive review of the alleged discrepancies...

Second Circuit Dicta Concerning FCA “Alternate Remedy” Provision May Create Perverse Incentive for Government to Increase Criminal Prosecution

The Second Circuit's decision in U.S. v. L-3 Communications EOTech, Inc., included ominous dicta pertaining to the "alternate remedy" provision of the False Claims Act (FCA), which may lead to an increase in government determinations to prosecute FCA matters criminally, rather than joining or "intervening" in an ongoing civil suit. The "alternate remedy" provision reads, in pertinent part, that "the Government may elect to pursue its claim [under the FCA]...

Provider ALERT: 2020 Medicare Physician Fee Schedule Includes Expansion of Revocation Authority

Upon the annual announcement of the Medicare Physician Fee Schedule, providers are typically focused on the new payment rates and policies, but the 2020 version includes an expansion of revocation authority about which all enrolled providers must be aware. The Centers for Medicare & Medicaid Services (CMS) has always retained the discretion to deny or revoke a provider's enrollment status and corresponding billing privileges for violations of CMS rules, but...

University of Rochester Medical Center’s $3 Million HIPAA Settlement

The University of Rochester Medical Center (URMC), one of the largest health systems in New York, recently agreed to a $3 million settlement for potential violations of the Health Insurance Portability and Accountability Act (HIPAA). In 2013, URMC filed a breach report to the United States Department of Health and Human Services, Office for Civil Rights (OCR) due to the loss of an unencrypted flash drive containing electronic Protected Health...

What Medical Practices Need to Know About Private Equity Transactions

https://www.youtube.com/watch?v=vfh4CULZsGE Part One of a Three-part Healthcare Private Equity Video Series In this video, attorney Daniel B. Frier, Esq., explains what Medical Practices need to know about Private Equity transactions, including: [00:01:19] What is Private Equity? [00:02:21] Why is Private Equity Interested in Medical Practices? [00:06:15] Why Would a Practice or Doctor Consider Private Equity? [00:10:17] Identifying a Private Equity Partner [00:11:39] Choosing and Using an Investment Banking Firm to...