Blog

»  Posts By    

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]...

Pharmacy ALERT: Pharmacies Receive Subpoenas Regarding RDC Contracts

State and local governments across the country have taken the opioid crisis head-on, many of them filing civil lawsuits against opioid manufacturers, wholesalers, distributors and healthcare providers. As part of these lawsuits, plaintiffs have been issuing subpoenas to pharmacies that purchased products, including opioids, from wholesalers and distributors, such as Rochester Drug Co-Operative, Inc. (RDC). The subpoenas request numerous documents and often require a significant amount of time and resources...

Plan Sponsor ALERT: PBMs “Double-Dipping” on Audit Fees from Pharmacies and Plan Sponsors

Millions of Americans across the country are employed by public-sector entities and other self-funded employers, insurers, and managed healthcare organizations (collectively "Plan Sponsors"), who often turn to Pharmacy Benefit Managers (PBMs) for the administration and management of pharmacy benefits. PBMs are tasked, among other things, with maintaining a network of pharmacies and monitoring the pharmacies' claims through various mechanisms, ranging from routine pharmacy audits to Fraud, Waste, and Abuse (FWA)...

Pharmacies Should Not Ignore These Prescription “Red Flags”

In the midst of the opioid epidemic, regulators have become increasingly focused on prescriptions that are not issued for a legitimate medical purpose. Pharmacies should be aware of the "red flags" or warning signs that may indicate the presence of a fraudulent or forged prescription, as the DEA and various state Boards of Pharmacy have revoked controlled substances permits and pharmacy licenses for pharmacies that have failed to resolve red...

Frier Levitt Helps Pharmacy Reverse PBM Termination

Frier Levitt recently reversed a PBM's decision to terminate a pharmacy due to alleged drug invoice shortage discrepancies. The pharmacy was terminated due to the results of a PBM's pre-credentialing audit that failed to take into account a variety of purchases made during and prior to the audit period. The PBM also failed to take into account an inventory that was purchased from the previous owner of the pharmacy. Using...
12