Blog

New CMS Final Rule Adds Non-Skilled In-Home Care as Medicare Advantage Benefit in 2019

The Centers for Medicare & Medicaid Services (CMS) recently announced a final rule allowing Non-skilled in-home care services as a supplemental benefit for Medicare Advantage (MA) plans in 2019. This is first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage. The announcement is a part of CMS' expanded definition of "primarily health related," which allows supplemental benefits if they compensate for physical impairments, diminish the...

Kentucky’s Attorney General Targets Walgreens for Role in State’s Opioid Crisis

Kentucky Attorney General Andy Beshear has filed suit against the Walgreens drugstore chain, claiming it failed to monitor its operations that shipped and dispensed large quantities of opioids throughout its more than 70 retail drugstores in Kentucky. The suit alleges that Walgreens failed to report to state and federal authorities suspiciously large orders it received for prescription opioids at the distribution level, and failed to monitor and flag suspicious prescriptions...

Frier Levitt Reverses PBM Termination and Reduces Recoupment by Over 86%

Frier Levitt recently assisted an independent pharmacy with a PBM audit in which the PBM claimed the pharmacy had inventory shortfalls for over twenty drugs. Frier Levitt reviewed the pharmacy's invoice documentation, and submitted an appeal on behalf of the pharmacy. While awaiting results of the appeal, the pharmacy received a notice of termination from the PBM based on the inventory shortfalls identified in the audit. Frier Levitt worked with the PBM...

Why Providers Need to Carefully Negotiate the Complex Payment and Penalty Provisions Under Shared Savings Agreements

 "Shared savings agreements" or "physician incentive plans" are agreements between provider groups and carriers or the government wherein bonus payments are paid, or penalties assessed, pursuant to a contractually agreed upon formula designed to measure quality-based performance over a given time period. As these relatively new agreements can be highly technical and the mechanics of the bonus calculation quite opaque (often by design), provider groups tend to take the bonus...

New York Physician Convicted for Opioid Overdose Deaths

On May 23, 2018, a federal jury convicted a New York doctor of causing the overdose deaths of two patients by illegally prescribing oxycodone. The doctor may face a mandatory minimum sentence of 20 years in prison and a $10 million fine. In an operation aimed at identifying providers who engage in negligent prescribing, an undercover detective acquired six oxycodone prescriptions from the doctor without a legitimate medical purpose during...