As earlier noted, the New York State Department of Health (“NYDOH”) and the New York State Department of Education (“NYSED”) promulgated a so-called “policy,” which is actually a poorly-disguised agency rule, precluding New York... Read More
Blogs & Articles | Community Oncology Practices & Other Dispensing Physician Practices | Life Sciences | Pharmacy Law | Physician Dispensing

Effective on January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) will implement the Final Rule for Medicare and Medicaid Programs. The Final Rule establishes pharmacy... Read More
Blogs & Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Pharmacy Transactions | Plan Sponsor PBM Contract Services

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
Blogs & Articles | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law

Since the onset of the COVID-19 public health emergency in March 2020, healthcare providers have operated under a variety of waived or relaxed regulatory requirements, particularly as it relates to licensing, telehealth, and Medicare and Medicaid... Read More
Blogs & Articles | COVID-19 Resources | Healthcare | Healthcare Law | Healthcare Practice Compliance | Telehealth and Telemedicine

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

Under the Section 340B federal discount drug program (340B program), pharmaceutical manufacturers enter into contracts with the Health & Human Services (HHS) in exchange for having their drugs covered by Medicaid and Medicare.  Pursuant to... Read More
Blogs & Articles | Life Sciences | Manufacturers | Pharmacy Law | Section 340B In-House and Contract Pharmacies

The United States Attorney’s Office for the District of Connecticut recently announced a civil settlement agreement with a behavioral healthcare organization that provides in-home family therapy and counseling in the greater Hartford area (the... Read More
Behavioral Health Practitioners | Blogs & Articles | Federal and State Fraud and Abuse Counseling | Healthcare | Healthcare Law | Healthcare Practice Compliance | Medicare and Insurance Audits

Earlier this week following a three-day bench trial, the owner of, and a licensed mental health counselor at, a Tallahassee-based counseling center, were found guilty of health care fraud conspiracy, health care fraud, and aggravated identity theft.... Read More
Blogs & Articles | Healthcare | Healthcare Law | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News & Press | White Collar Criminal Defense & Government Investigations

The “law” applicable to drug reimbursement encompasses an array of laws across 50 states, the territories, and the federal government. These laws and regulations determine what a “Plan Sponsor” (such as an insurance plan, State Medicaid... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Maximum Allowable Cost Pricing & Appeals | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News & Press | Pharmacy Law | Plan Sponsor PBM Contract Services