In October 2022, Pennsylvania’s former Governor Tom Wolf, before leaving office, signed House Bill 1630 (“HB 1630”) into law. HB 1630 grants the Pennsylvania Auditor General authority to audit pharmacy benefit managers (“PBMs”) that... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Defending Pharmacies in PBM Audits | DIR Fees | Managed Care Negotiations and Strategies | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Plan Sponsor PBM Contract Services

As previously discussed in our article in June 2022, the New York Department of Health (“NYDOH”) has taken the position that community pharmacies that have dual enrollment with Medicare as both a pharmacy provider (through CMS-855B enrollment)... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Section 340B In-House and Contract Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Veterinary Compounders

The Court of Appeals for the Third Circuit recently issued its decision in the consolidated cases of drug manufacturers Sanofi, Novo Nordisk, and AstraZeneca ruling in the drug manufacturers favor versus the Department of Health & Human Services... Read More
340B Covered Entity and Contract Pharmacy Regulatory and Contract Support | Articles | Chain Pharmacies | Clinically Integrated Networks | Clinically Integrated Networks (CINs) | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Digital Pharmacies | Dispensing Physician Practices and Dispensing Physicians | Fertility Pharmacies | Hospitals and Healthcare Systems | Integrated Delivery Network | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Section 340B In-House and Contract Pharmacies | Specialty Pharmacies | Supermarket Pharmacies

A staple of Medicare and False Claims Act (“FCA”) law – the so-called “Overpayment Rule” – may soon be undergoing a dramatic shift, and doing so in a way that could increase liability for healthcare providers while potentially reducing... Read More
All types of single and multi-specialty medical practice groups | Articles | Behavioral Health Practitioners | Healthcare Practice Compliance | Medical Practice Representation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Physicians and Medical Practices of all Specialties

Frier Levitt Partner Jason N. Silberberg was quoted in a Modern Healthcare article, “More MA Insurer Audits Mean More Scrutiny on Providers” by Lauren Berryman. The Final Rule set to be implemented on February 1, 2023 is likely to increase the... Read More
Articles | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News | Publications

Earlier this month, the Centers for Medicare and Medicaid (“CMS”) released a Memorandum overviewing next steps in the federal government’s implementation of the Medicare Drug Price Negotiation Program. Though CMS has only just “set the... Read More
Articles | Manufacturers | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Manufacturers

On September 23, 2022, the Fourth Circuit issued a per curiam opinion upholding the dismissal of a 2014 qui tam suit against Forest Laboratories, LLC while vacating both the district court and subsequent Fourth Circuit panel opinions. Although the... Read More
Articles | Federal and State Fraud and Abuse Counseling | Manufacturers | Maximum Allowable Cost Pricing & Appeals | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Manufacturers | Pharmaceutical Wholesalers | White Collar Criminal Defense & Government Investigations

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
All types of single and multi-specialty medical practice groups | Articles | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Digital Pharmacies | DIR Fees | Dispensing Physician Practices and Dispensing Physicians | Healthcare | Healthcare Law | Healthcare Practice Compliance | Life Sciences | Medicare and Insurance Audits | Medicare Audit Appeals | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Wholesalers | Physician Dispensing | Physician Dispensing | Physicians and Medical Practices of all Specialties | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)