Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients. By George F. Indest III, J.D., Let’s see.

Fraud 40

Fraud Medicare Medicare Governance 40

Hall Render

APRIL 6, 2022

The relator alleged that these programs and subsequent reporting of the retail price, and not the discounted price, violated Medicare Part D’s requirement that a pharmacy must report the usual and customary price charged for the drugs. SuperValu Inc., of America v. Burr was applicable to lawsuits brought under the False Claims Act.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Health Law RX

JUNE 2, 2023

The Court’s Supervalu Decision Supervalu involved two combined FCA cases, both brought against supermarkets (Supervalu and Safeway) that house internal pharmacies and that participate with Medicare and Medicaid. [6] per 30-day supply). [9] per 30-day supply). [10] 12] The Court unanimously disagreed. per 30-day supply). [9]

Fraud 52

Fraud Governance Medicaid Medicaid 52

Health Care Law Brief

JUNE 20, 2023

The District and the Seventh Circuit Endorsed a Pure Objective Reasonableness Standard for FCA Scienter In this case, the relator alleged that certain pharmacies, among other things, misreported their pricing of certain drugs covered by Medicare and Medicaid. See Safeco Ins. of America v. Burr , 551 U.S.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Verisys

FEBRUARY 1, 2022

Providers also need an NPI prior to enrolling in Medicare. In July 1993, the Centers for Medicare and Medicaid Services ( CMS ) undertook a project to develop a healthcare provider identification system to meet the needs of the Medicare and Medicaid programs and the needs of a national identification system for all providers.

Fraud 52

Fraud Medicare Medicare HIPAA 52

Health Populi

JUNE 13, 2018

Here is the first “good news” line chart, showing declining medical trend from 2007 to next year in 2019. That’s one-half the high point at nearly 12% in 2007. As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S.

Medicaid 63

Medicaid Medicaid Health Insurance Medicare 63

Jane Sarashon

FEBRUARY 28, 2022

I started the Health Populi blog in September 2007 with a post titled “Health Care is the #1 Line Item in Our National Economy… and Taking More Out of Your Pocket,” displaying this sign from Tom’s Shell gas station comparing the price of gas to an “Arm, Leg, or your First Born” posted on their sign in 2007.

COVID-19 59

COVID-19 Health Insurance Medicaid Medicaid 59

HIT Consultant

SEPTEMBER 12, 2024

The Centers for Medicare & Medicaid Services (CMS) broached the idea for a National Directory of Health Care Providers and Services (NDH) in 2018, putting out a request for information on the topic in 2022 which underscores the importance of this issue. million providers and organizations in the United States.

Hospitals 59

Hospitals Medicaid Medicaid Public Health 59

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Launched in 2007, star ratings enable the CMS as well as consumers to compare health plans on metrics other than cost. The CMS star ratings challenge. Industry trends.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

The Health Law Firm

SEPTEMBER 23, 2013

The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. Indest III, J.D., Board Certified by The Florida Bar in Health Law A group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5

Fraud 40

Fraud Medicaid Medicaid Medicare 40

The Health Law Firm

OCTOBER 9, 2012

In September 2012, the Centers for Medicare and Medicaid Services (CMS) made the decision to allow Recovery Audit Contractors (RACs) to begin reviewing the billing codes for office visits for healthcare providers. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law. Connolly, Inc.,

Medicaid 40

Medicaid Medicaid Doctors Medicare 40

New Jersey Healthcare Blog

JANUARY 12, 2022

10:191, Children’s Partial Care Programs, by the Department in 2007; and N.J.A.C. 1846(a), the Department of Human Services, Division of Medical Assistance and Health Services published a notice of readoption of New Jersey Care … Special Medicaid Programs Manual. 10:69, AFDC-Related Medicaid, or 10:71, Medicaid Only.

Licensing 40

Licensing Medicaid Medicaid Nurses 40

Health Populi

FEBRUARY 21, 2019

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs. recorded in 1990-2007.

Medicare 91

Medicare Medicare Medicaid Medicaid 91

Healthcare Law Blog

MAY 25, 2022

First, the decision resolved a previous split between the Fifth Circuit and the Eleventh Circuit; the latter of which ruled, in 2007, that emotional distress damages are available under the Rehab Act. [1] The Supreme Court communicated its intent to limit enforcement in several ways. But what constitutes “traditional” contract damages?

ACA 52

ACA Governance Medicaid Medicaid 52

Kaiser Health News

JUNE 29, 2022

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Medicare Advantage plans accept a set fee from the government for covering a person’s health care.

Medicare 107

Medicare Medicare Governance Overpayments 107

Jane Sarashon

DECEMBER 20, 2023

Dr. Robert Pearl has recently written about this, and the phenomenon has been a major recurring theme in this Health Populi blog since its inception in 2007 – when I launched this site in the midst of The Great Recession. There’s a sort of health care “shrinkflation” that has been shaping patients-as-payors of medical bills.

Prescription Drug Pricing 72

Prescription Drug Pricing Medical Billing Health Insurance Public Health 72

Drug & Device Law

JANUARY 25, 2024

142 (2007), mere regulation of the product or conduct at issue—the medical walker is a non-prescription, Class I medical device with general controls only—is not a basis for removal under this statute. The UHC entities offered a number of arguments that involve details of Medicare Part C that we will leave to others.

Medicare 52

Medicare Medicare FDA Regulatory Compliance 52