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pharmacy

Claims Denials Start April 1: What You Should Know About CMS’s New Preclusion List

[02/15/19]

Posted on February 15, 2019 in Health Law News

Published by: Hall Render

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

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OIG Issues Favorable Advisory Opinion on Prescription Drug Discount Program

[08/11/16]

Posted on August 11, 2016 in Health Law News

Published by: Hall Render

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued a favorable Advisory Opinion, No. 16-07, of an arrangement that offers Medicare Part D beneficiaries discounts on prescriptions for an erectile dysfunction drug that is statutorily excluded from coverage under Part D (the “Arrangement”). While OIG concluded that the Arrangement... READ MORE

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7th Circuit Rules “Usual and Customary Pricing” Can Include Discount Programs

[05/31/16]

Posted on May 31, 2016 in False Claims Act Defense

Written by: David B. Honig

A recent whistleblower case could have a significant impact on Medicare Part D charge limits and corresponding reimbursement and could have ripple effects for aspects of other Medicare programs. The Seventh Circuit Court of Appeals ruled that reduced prescription prices offered by a large retail pharmacy (here Kmart) to participants enrolled in a popular discount... READ MORE

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Indiana Pharmacists Not Subject to Private Lawsuits for Refusal to Fulfill Prescriptions

[02/12/15]

Posted on February 12, 2015 in Litigation Analysis

Written by: Drew B. Howk

Recently, a federal District Court for the Northern District of Indiana ruled that pharmacists in Indiana are not subject to patient lawsuits for their refusal to dispense certain prescriptions but can be sued by prescribing physicians for related claims or face administrative actions by the state for improperly refusing to fill a prescription.  Therefore, pharmacies and pharmacists should carefully determine when they... READ MORE

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Seventh Circuit Rejects Novel Fraud Theory

[11/13/14]

Posted on November 13, 2014 in False Claims Act Defense

Written by: David B. Honig

Relator Thulin was a pharmacist in Idaho working for Shopko, a Wisconsin company. He filed an FCA claim alleging Shopko defrauded Medicaid by failing to pass along private insurance plan prices to Medicaid for dual-eligible patients. The court rejected Shopko’s claim, affirming the trial court’s grant of a motion to dismiss. Dual-eligible Medicaid recipients... READ MORE

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OIG Scrutinizes Specialty Pharmacy Arrangement in Unfavorable Advisory Opinion

[08/26/14]

Posted on August 26, 2014 in Health Law News

Published by: Hall Render

OIG recently issued Advisory Opinion 14-06, determining that a proposed arrangement for patient referrals to a specialty pharmacy had the potential to generate prohibited remuneration under the Anti-Kickback Statute.  The proposed arrangement involved a specialty pharmacy paying a support services fee to local retail pharmacies when the local pharmacies referred patients to the specialty... READ MORE

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OIG Releases Advisory Opinion on Pharmaceutical Direct-to-Patient Sales Program

[08/07/14]

Posted on August 7, 2014 in Health Law News

Published by: Hall Render

Executive Summary On July 28, 2014, the Department of Health and Human Services Office of Inspector General (“OIG”) released Advisory Opinion No. 14-05 (“AO 14-05”), addressing one of OIG’s favorite foci, federal health care program “carve out” arrangements.  AO 14-05 was issued in response to a pharmaceutical manufacturer’s (“Company”) request for review of its... READ MORE

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Kentucky APRNs Granted Expanded Prescribing Authority

[07/17/14]

Posted on July 17, 2014 in Health Law News

Published by: Hall Render

On July 15, a new law in Kentucky took effect that expands the prescribing authority for advanced practice registered nurses (“APRNs”). Kentucky Revised Statutes 314.042 allows APRNs that have been prescribing non-scheduled legend drugs under physician supervision for four years to prescribe these drugs without physician oversight. Proponents of the law say that the... READ MORE

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Recently Filed Legislative Updates Affect Prescription Drug Reporting

[07/15/14]

Posted on July 15, 2014 in Health Law News

Published by: Hall Render

Kentucky pharmacists take note: soon you may have to update your prescription drug tracking and dispensation procedures to reflect proposed changes to the Kentucky Administrative Regulations. Section 045 of Chapter 55 in Title 902 of the Kentucky Administrative Regulations currently contains a list of drugs that are excluded from the licensing, distribution, recordkeeping and... READ MORE

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OIG Updates Guidance on Prescription Drug Patient Assistance Programs

[06/25/14]

Posted on June 25, 2014 in Health Law News

Published by: Hall Render

Executive Summary The Department of Health & Human Services Office of Inspector General (“OIG”) recently released a Supplemental Special Advisory Bulletin (“Supplemental Bulletin”) on the potential fraud and abuse implications of prescription drug patient assistance programs (“PAPs”).  The Bulletin updates OIG’s 2005 Special Advisory Bulletin (“2005 Bulletin”) on PAPs for Medicare Part D enrollees... READ MORE

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