Blog

ESI Recoupment Letters: Absence of Prescriber-Patient Relationship

At the request of the Defense Health Agency (“DHA”), Express Scripts, Inc. (“ESI”) has begun sending letters to some of the pharmacies within its network recouping on claims that had been submitted to TRICARE. This recent batch of letters is particularly notable because they focus on the results of DHA investigations – as distinct from an audit – a particularly powerful tool that enables ESI to evaluate and review claims...

Dental Provider Alert: ADA Requests FCC to Support Teledentistry

Since the declaration of a national public health emergency, oral health providers have postponed most non-emergent care, whether as required by state-issued directives, or as recommended by the Interim Guidance for Minimizing Risk of COVID-19 Transmission from the American Dental Association (“ADA”).  A recent ADA survey found that 80% of dentists are only seeing emergency patients at this time.  Teledentistry provides an avenue for dentists to furnish a variety of...

Pharmacy Alert: Opioid Plaintiffs’ Attorneys Sending Accusatory Letters to Pharmacies

As we reported here, attorneys representing state and local governments in the opioid litigation issued subpoenas to pharmacies that purchased narcotics from certain wholesalers and distributors.  Notably concerning, the same attorneys are now sending out letters to pharmacies accusing them of contributing to the opioid crisis.  These letters claim, without providing any details or basis, that the pharmacies were negligent in the practice of dispensing prescription opioids.  Even more troubling,...

Let’s Talk: COVID-19 and the Temporary Shutdown of Pharmacies and Medical Practices

https://www.youtube.com/watch?v=G2-iGKlATyU&feature=youtu.be In these trying times many pharmacies and medical practices are facing some degree of temporary shutdowns. Co-Founding Partner Jonathan Levitt, Esq. and our Managing Partner of our New York Office John Morrone, Esq. discuss what providers should know regarding temporary shutdowns.

Troubling Reimbursement Scheme Impacting Out-of-Network Providers

Reimbursement disputes between healthcare providers and plans/plan sponsors (Payers) involving Out-of-Network (OON) claims have taken a center stage in the healthcare industry as well as in the court system.  Indeed, there has been a series of lawsuits filed by providers such as plastic surgeons and ambulatory surgery centers against self-funded, ERISA-regulated health plans that have either underpaid or failed to pay providers for OON claims.  Critically, Frier Levitt has become...