Pharmacy benefits manager (PBM) Caremark has now placed Trimester 1 Reports for year 2022 in the Caremark Provider Portal.  Caremark provides its summaries of Direct and Indirect Remuneration (DIR) Fees paid by participating pharmacy providers for... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | DIR Fees | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law | Specialty Pharmacies

On May 9, 2022, the Centers for Medicare and Medicaid Services (CMS) released a Final Rule (Final Rule) entitled, “Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.” ... Read More
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The New York Department of Health (NYDOH) has promulgated enrollment requirements for pharmacies seeking to participate in the Medicaid program which are unrelated to many of the actual operations of pharmacies within the state of New York.... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Digital Pharmacies | Fertility Pharmacies | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

The government increasingly has its sights set on various healthcare frauds that result in major financial losses to its healthcare programs such as Medicare, Medicaid, and TRICARE. Recently, the expanded enforcement efforts have included the foot... Read More
Articles | Community, Retail Pharmacies | Digital Pharmacies | Dispensing Physician Practices and Dispensing Physicians | Federal and State Fraud and Abuse Counseling | Federal and State Fraud and Abuse Counseling | Healthcare Practice Compliance | Life Sciences | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Physician Dispensing | Physician Dispensing | Physicians and Medical Practices of all Specialties | Provider Relationship | Specialty Pharmacies | Supermarket Pharmacies | White Collar Criminal Defense & Government Investigations | White Collar Defense and Government Investigation

On April 20, 2022, the Department of Justice (DOJ) announced criminal charges against twenty-one (21) defendants in nine federal courts across the country for their roles in Coronavirus-related healthcare fraud schemes that resulted in more than... Read More
All types of single and multi-specialty medical practice groups | Articles | Federal and State Fraud and Abuse Counseling | Federal and State Fraud and Abuse Counseling | Healthcare | Healthcare Practice Compliance | Hospitals and Healthcare Systems | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Physicians and Medical Practices of all Specialties | Telehealth and Telemedicine | Telehealth and Telemedicine | White Collar Defense and Government Investigation

On April 4, 2022, U.S. District Judge Bernard M. Jones invalidated parts of Oklahoma’s Patient’s Right to Pharmacy Choice Act (the “Act”) in PCMA v. Mulready et al. concluding that certain provisions in the law were preempted under Medicare... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law

Pharmacy Benefits Managers (PBMs) often make changes to their contracts with pharmacies through notice alone that does not require a signature from the pharmacy.  At least one PBM recently issued such a notice to pharmacies regarding a new Medicare... Read More
Articles | Defending Pharmacies in PBM Audits | DIR Fees | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law

In yet another high-profile legal action, health insurance giant, Humana, has demonstrated its appetite to go after pharmaceutical manufacturers, supporting hubs and specialty pharmacies involved in patient assistance programs.  This past week,... Read More
Articles | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Manufacturers | Pharmacy Law | Specialty Pharmacies

The State of Texas recently enacted H.R. 3459, a law that permits prescribers to earn a “gold card” exemption from Prior Authorization (PA) requirements based on a track record of previous PA approvals from insurers (preferred provider and... Read More
Articles | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law

A Texas husband and wife dentist team recently reached an agreement with the United States Department of Justice (“DOJ”) to pay $3.1 Million to resolve allegations that they violated the False Claims Act (“FCA”) by defrauding the Texas... Read More
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