CMS Archives | Frier Levitt - Attorneys at Law

What’s Next? What to Expect in Post COVID-19 Government Oversight and Enforcement Actions for Long Term Care and Skilled Nursing Facilities.

Abdul J. Roberts, Esq. and Guillermo J. Beades, Esq. June 30, 2021

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

CMS Audit Considerations After the Pandemic

Alan R. Blankstein, Esq. and Guillermo J. Beades, Esq. June 9, 2021

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

Provider Alert: Neglecting to Update Your Medicare and/or Medicaid Enrollment Status and/or Maintain Enrollment Requirements May Result in Revocation

Theresa M. DiGuglielmo, Esq. and Jason N. Silberberg, Esq. June 1, 2021

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

Frier Levitt Secures Near Eight-Figure Settlement In Connection with Value-Based Care Contract Dispute

Jonathan Levitt and Jason N. Silberberg, Esq. May 17, 2021

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

Anthony Mahajan authors article for Total Pharmacy titled “Part D Participants Should Validate Audit Processes for Prescription Drug Event Data.”

Anthony J. Mahajan, Esq. May 10, 2021

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

The “Reverse” False Claim: A Cautionary Tale for Providers with Lax Compliance

Abdul J. Roberts, Esq., Guillermo J. Beades, Esq. and Jason N. Silberberg, Esq. April 29, 2021

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

PROVIDER ALERT: OIG Report Appears to Indicate that Medicare Advantage Organization, Humana, Inc. May Be Significantly Underpaying Downstream Contracted Providers in Global Risk Capitation Arrangements

Jason N. Silberberg, Esq. and Jonathan E. Levitt, Esq. April 29, 2021

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

Growing Chorus of Courts Hold Otherwise Accurate PDE Data May Support FCA Liability; Part D Participants Should Validate Audit Processes and Internal Controls

Anthony J. Mahajan, Esq. April 22, 2021

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

Lessons Learned from the First Wave of COVID-19: How to Navigate the Second Wave and Implement Lasting Changes to Benefit your Practice

Guillermo J. Beades, Esq., Wiks Moffat, CHC, Jim Tudor, PCA, CPC and Frier Levitt February 1, 2021

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 Successfully Obtains a $6.25 Million Settlement on Behalf of Its Plan Sponsor Client Against a Pharmacy Benefits Manager

Christopher Caltavuturo, Esq., Dae Y. Lee, Esq., Pharm.D CPBS and Todd Mizeski, Esq. December 23, 2020

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

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