Medicare Compliance & Reimbursement
PBM TARGETED IN NEW WHISTLEBLOWER SUIT
Enforcement trends spell trouble for drug industry and its business partners "Follow the money" may be code for "follow the drugs" when it comes to the latest trends in health care fraud enforcement. Pharmaceutical manufacturers are getting busted for average wholesale price shenanigans and Medicaid rebate snafus, physicians are getting nailed on pharma-related kickback charges, and pharmacy benefit managers appear to be in the crosshairs as well. The latest development: The Department of Justice June 23 partially intervened in a pair of whistleblower suits accusing Franklin Lakes, NJ-based PBM Medco Health Solutions Inc. of violating the False Claims Act in connection with its mail order program. Filed by a physician and two Medco employees, the suits accuse the PBM of, among other things: The feds' intervention is limited to counts one and two of the 3-count case filed by Dr. Joseph Piacentile and count one of the 35-count complaint filed by pharmacists and former Medco employees George Hunt and Walter Gauger. Med-co maintains that the whistleblowers' allegations are either outright wrong or reflect old problems that have since been corrected. Lesson Learned: Scrutiny of the pharma industry, along with stepped up scrutiny of Medicaid abuses, could fuel the next big wave of health care fraud enforcement.
Medicare Compliance & Reimbursement
- Medicare Rx:
HOUSE AND SENATE VOTE TO OVERHAUL MEDICARE
In the early morning hours of June 27, both the House and the Senate passed [...] - Medicare Perspectives:
MEDICARE Rx: EVEN WHEN IT'S OVER, IT WON'T BE OVER
Medicare legislation to add a prescription-drug benefit and inject more private health-plan competition into the [...] - QIOs:
COURT: QIOS MUST TELL COMPLAINING SENIORS MORE
A Medicare quality improvement organization must tell a complaining beneficiary, at a minimum, whether or [...] - Uninsured:
EXPANDING COVERAGE IS WORTH IT FOR ALL, IOM PANEL INSISTS
Many Americans fail to reach their developmental potential, and public programs like Medicare, the employment [...] - PBMs:
PBM TARGETED IN NEW WHISTLEBLOWER SUIT
Enforcement trends spell trouble for drug industry and its business partners "Follow the money" may [...] - Overpayments:
WHITE HOUSE OVERPAYMENT GUIDANCE HITS YOUR BOTTOM LINE
Well documented claims are more important than ever Your chances of being targeted for payback [...] - Business Arrangements:
MRI JV PASSES OIG MUSTER
Four key elements win over the feds Despite the HHS Office of Inspector General's longstanding [...] - Physicians:
DOCS GET RELIEF ON FEE SCHEDULE ADJUSTMENT
Potential cash flow mess averted Good news for doctors: Physicians won't have to cough up [...] - Home Health:
HHAs IN LINE FOR 3.3 PERCENT RAISE
PPS update in line with expectations Home health agency Medicare payment rates will go up [...] - BILL WATCH
The following House bills were introduced: H.R. 2560. A bill to amend title XVIII of [...]
