The US Department of Justice reached a settlement with a Kansas-based supplier of mail-order diabetic supplies to resolve allegations of submission of false claims to federal healthcare programs. The settlement requires that the defendants pay a... Read More
More often than you may realize, reimbursement checks are lost, destroyed or otherwise not deposited by your pharmacy. Claims reconciliation is complex and your pharmacy may be unaware of "unclaimed funds". PBMs could be holding "unclaimed funds"... Read More
In recent months, we have seen a new audit focus emerge among various pharmacy benefits managers (PBMs) that is catching pharmacies by surprise and resulting in large recoupments and even network termination. It starts with a PBM requesting, in the... Read More
By Jesse C. Dresser, Esq. and Jonathan E. Levitt, Esq. Earlier this month, Oregon Governor John Kitzhaber signed H.B. 2123 into law, which provides for sweeping oversight of pharmacy benefits mangers (PBMs) in the Oregon. H.B. 2123 implements fair... Read More
In recent weeks and months, OptumRx, the in house pharmacy benefits manager (PBM) for UnitedHealthcare has engaged in a new course of action challenging Florida pharmacies that provide diabetic testing supplies through mail order. Contending that... Read More
State Boards of Pharmacy (BOPs) have begun requesting very specific information from prescribing physicians about compounded medications. Pre-printed prescription pads and “office-use” are hot topics. Your pharmacy’s compliance with state... Read More
On May 8, 2013, the OIG issued a “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” This “Special Advisory” reiterated and clarified the obligations of providers to assess the status of... Read More
The U.S. Department of Health and Human Services (HHS) issued new rules (Final Rule) established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act... Read More
Your pharmacy has an affirmative legal obligation to ensure that it does not associate with (i.e., employ, transact business with, fill prescriptions for, etc.) an individual or entity that is currently excluded from participation in Medicare,... Read More
Late last month, the United States Department of Justice announced that Walgreens Pharmacy had agreed to pay $7.9 million to settle allegations that Walgreens had violated the Federal False Claims Act. In a suit brought as a qui tam action by a... Read More
