As the nation reels from the heartbreaking COVID-19 pandemic, scrutiny of Skilled Nursing Facilities and Long-Term Care facilities is all but certain to continue. Industry leaders and recent data suggests providers anticipate enhanced oversight from... Read More
Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Healthcare Litigation | Healthcare Practice Compliance | Managed Care Negotiations and Strategies | Skilled Nursing Facilities and Long-Term | Value Based Care

Early in the COVID-19 outbreak, on April 2, 2020, the Centers for Medicare and Medicaid Services (“CMS”) issued a suspension of most of their audit activities.  This suspension was in place until August 5, 2020, when most audit activities... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Medicare and Insurance Audits

Providers enrolled in Medicare and/or Medicaid are aware of the myriad of rules associated with coverage for services and the submission of claims, but they are sometimes surprised to learn that neglecting to update their enrollment status and... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | Community, Retail Pharmacies | Healthcare | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law

Physician groups contracting with government-regulated health plans such as Medicare-Advantage Organizations, Medicaid Managed Care Organizations, or ACA Marketplace Individual/Small Group Issuers often enter into capitated payment models with... Read More
Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Recent Results | Recent Successes | Value Based Care | Value Based Care

Frier Levitt Partner, Anthony J. Mahajan, Esq. has authored an article in the May 10, 2021 issue of Total Pharmacy titled "Part D Participants Should Validate Audit Processes for Prescription Drug Event Data."  The premise of the article... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | News & Press | Pharmacy Law | White Collar Criminal Defense & Government Investigations

With the onset of the pandemic and the flood of claims submitted by providers to government payors in connection with it – such as claims for COVID testing or upwardly (risk) adjusted PMPM capitation payments – comes substantial risk for the... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits

Following the release of an April 16, 2021 HHS Office of Inspector General (“OIG”) report entitled “Medicare Advantage Compliance Audit of Diagnosis Codes that Humana, Inc. (Contract H1036) Submitted to CMS” (the “OIG Report”), headlines... Read More
All types of single and multi-specialty medical practice groups | Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News & Press | Value Based Care

A district judge in New Jersey recently permitted the relator in United States ex rel. Silver v. Omnicare Inc., No. 11-cv-01326 (D.N.J. Apr. 13, 2021), to file an amended complaint alleging that a pharmacy’s submission of dispensing data to a Part... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Pharmacy Law | White Collar Criminal Defense & Government Investigations

by Guillermo Beades, Esq. of Frier Levitt, LLC, Wiks Moffat, CHC, of HealthCare Compliance Network, LLC, and Jim Tudor, PCA, CPC, of HealthCare Compliance Network, LLC When the COVID-19 pandemic reached our shores, it instantly changed the way we... Read More
Blogs & Articles | COVID-19 Resources | Telehealth and Telemedicine

Frier Levitt recently obtained a $6.25 Million settlement against a Pharmacy Benefits Manager(“PBM”) on behalf of its Plan Sponsor client (“Plan”). The Plan contracted with the PBM to administer its prescription drug program, and to... Read More
Blogs & Articles | Life Sciences | Pharmacy Law | Plan Sponsor PBM Contract Services | Recent Results | Recent Successes