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California Passes Pharmacy Benefit Management Bill

California has joined a number of other states, including Vermont and Washington, in requiring pharmacy benefit managers (PBMs) to register with a state department. Assembly Bill 315 (AB 315), Pharmacy Benefit Management was signed by California Governor Jerry Brown on September 29, 2018 and became effective January 1, 2019. The…

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SUPPORT Act Expands Reporting Responsibilities Required by the Sunshine Act

In response to the current opioid crisis sweeping across the country, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (commonly referred to as the SUPPORT Act). President Trump signed the Act on October 24, 2018, which will take full effect on…

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Courts Recognize Irreparable Injury Caused by Medicare Appeals Backlog

This is a summary of the article Courts Recognize Irreparable Injury Caused by Medicare Appeals Backlog written by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., published in the January/February 2019 issue of BC Advantage. Presently, there are 426,594 appeals pending and awaiting OMHA adjudication. Despite a statutory mandate to…

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HHS Announces New Site-Neutral Payment Policy – And Is Met With Another Lawsuit

As of January 29, 2019, a total of 38 hospitals have joined a lawsuit against the Department of Health and Human Services (HHS) over the new site-neutral payment policy that went into effect beginning January 1, 2019. The final rule that modified the Outpatient Prospective Payment System (OPPS) will result…

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CMS Finalizes Changes to the Medicare Shared Savings Program

The Center for Medicare and Medicaid Services (CMS) has published a 957-page final rule that confirms changes made to the Medicare Shared Savings Program (MSSP). This new rule will be expected to have a substantial impact on Accountable Care Organizations (ACOs) that rely on one-sided risk models, in so far…

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Pennsylvania Act 112 – Imaging Entities Now Required to Report to Patients on “Significant Abnormalities”

The Patient Test Result Information Act – commonly referred to as Act 112 – now requires Pennsylvania imaging entities to directly communicate with patients if the entity finds “significant abnormalities” in the patient’s test results, as well as to continue to follow normal reporting procedure to inform the ordering physician.…

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The October 2018 Updates to the National Practitioner Data Bank Guidebook Expands on Physician Reporting Requirements

Established in 1986, the National Practitioner Data Bank (“NPDB”) is a “repository of reports that contain information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers.” NPDB website. Under the NPDB, hospitals and other entities with peer review committees, health plans, and numerous…

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Hospice Company SouthernCare Inc. to Pay $6 Million in Medicare Fraud Settlement

Two cases brought against an Alabama-based hospice company will result in an almost $6 million settlement payment. In two whistleblower complaints filed in 2013 by two former employees, one of which who worked as a clinical director in a Pennsylvania branch, SouthernCare Inc. is accused of wrongly billing Medicare for…

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Robert S. Iwrey selected as a 2019 Top Lawyer in Health Care Law

HLP is excited to announce the selection of Robert S. Iwrey, Esq. as a Top Lawyer in Health Care Law for 2019 by dbusiness Magazine! dbusiness, Detroit’s Premier Business Journal, selects its Top Lawyers by peer review survey, which polled 19,000 attorneys in the metro Detroit area. The poll asks…

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Labs, Clinical Treatment Facilities and Recovery Homes Subject to New All Payor Anti-Kickback Law

The Eliminating Kickbacks in Recovery Act of 2018 (“EKRA”) became effective October 24, 2018. ERKA makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive any remuneration (i.e., anything of value), directly or indirectly, overtly or covertly, in cash or in kind, to induce a referral…