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It is the twenty-second year of the Health Care Fraud and Abuse Control Program (HCFAC) established by the Health Insurance Portability and Accountability Act of 1996. The HCFAC’s annual report for 2018 shows continued focus on preventing and eliminating fraud, waste and abuse from the Medicare and Medicaid programs and increased cooperation between government agencies to facilitate data sharing. Continue reading » The Centers for Medicare & Medicaid Services (“CMS”) announced in April of this year that it is adding 12 new HCPCS codes to the Required Prior Authorization List of DMEPOS items that require prior authorization as a condition of payment. Prior authorization for Pressure Reducing Support Surfaces will be implemented nationwide in October. Continue reading » On July 2, 2019, New Jersey’s Governor, Phil Murphy, signed into law the Jake Honig Compassionate Use Medical Cannabis Act (“Act”) (previously known as the New Jersey Compassionate Use Medical Marijuana Act) which greatly expands and reforms New Jersey’s Medical Marijuana program. Several of the legislative updates are based on the recommendations made by the New Jersey Department of Health March 2018 Report (drafted pursuant to Executive Order No. 6). Below we highlight some of the significant changes. Continue reading » New Jersey pharmacy owners know that every New Jersey pharmacy must appoint a Pharmacist-In-Charge (“PIC”) and a pharmacy cannot operate without a PIC for longer than 30 days. Below we review some of the many responsibilities that go with the title. Continue reading » OCR Proposes Changes to the Civil Rights Enforcement Section of the Affordable Care Act Section 1557The Department of Health and Human Services (“HHS”) and the Office of the Civil Rights (“OCR”) recently proposed changes to Section 1557 of the Affordable Care Act (“Act”). This Section of the Act prohibits civil rights discrimination in certain health programs or activities. Some of the major changes, include, among others, revising the regulatory definition of what constitutes discrimination on the “basis of sex”. The proposal also includes healthcare conscience protections. Additionally, the proposed rule would eliminate taglines and notices requirement and it would revise the language access and grievance procedures of the rule. Continue reading » An electronic medical records company recently settled with the Office of the Civil Rights (“OCR”) for violating the Health Insurance Portability and Accountability Act (“HIPAA”) following a discovery of a cyberattack on its servers which contained the protected health information (PHI) of approximately 3.5 million individuals. Continue reading » The New Jersey Department of Health’s recent biannual report recommended ways to improve the New Jersey’s Medical Marijuana Program in three key areas. Continue reading » The Office of the Inspector General (“OIG”) recently published the False Claims Act settlements risk spectrum for the first quarter of 2019. The risk spectrum identifies the number of settled cases and their assigned risk category. Continue reading » Many website design and development contracts as well as marketing and electronic medical records agreements (“technology contracts”) contain onerous terms and layers of user fees. If a physician or a dentist (“provider”) decides to part ways with the vendor under a technology contract the transition may be costly or cost prohibitive. One of the best ways providers can protect themselves against a slue of additional costs and concerns about possible loss of data is to have the contract reviewed by a healthcare attorney before signing on the dotted line. Continue reading » In a newly proposed rule the Office of the Inspector General (“OIG”) is proposing to exclude from the discount safe harbor certain types of remuneration offered by drug manufacturers to Part D plan sponsors and Medicaid MCOs that may pose a risk to the Federal health care programs and beneficiaries. The OIG is also proposing to add two new safe harbors. The first would protect certain manufacturer point-of-sale reductions, and the second would protect certain fixed service fees that manufactures pay to pharmacy benefits managers for services rendered to the manufacturer that meet specific criteria. Continue reading » The New Jersey Board of Pharmacy and the New Jersey Board of Medical Examiners recently adopted new regulations and amended existing ones that effect the way providers practice. The changes concern pediatric immunizations performed by pharmacists and the administration of subcutaneous and intramuscular injections and venipunctures by certified medical assistants. We briefly summarize these recent changes below. Continue reading » The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule that, if codified, would bring about sweepings revisions to many Medicare payment policies under the physician fee schedule. Among many other changes CMS is proposing to simplify the documentation requirement for evaluation and management (E/M) code levels 2 through 5 but also proposes a flat fee for those levels of services. These and certain other proposed policy changes are briefly summarized below. Continue reading » New sweeping regulations went into effect on July 1, 2017 for dental anesthesia services in New York. The regulations, among other things, would require dentists to meet specific practice requirements, maintain more exacting records than previously required and complete additional and specific continued education courses. The regulations will also impose more stringent requirements on dentists providing dental sedation to patients 12 years old and younger. Below is a brief summary of the new requirements. Continue reading » New York State Office of the Medicaid Inspector General (OMIG) annual 2018-2019 Work Plan highlights three areas of concern for the agency: (1) provider compliance; (2) identifying and addressing fraud, waste and abuse in the program; and (3) improving methods of detecting fraudulent activities. Continue reading » The Division of Consumer Affairs (Division) is proposing to amend the Prescription Monitoring Program (PMP) rules to require New Jersey licensed pharmacies and registered out-of-State pharmacies to electronically transmit information to the Division about prescriptions filled for gabapentin. Continue reading » The Bureau of Compliance (BOC) within the New York State Office of the Medicaid Inspector General (OMIG) recently performed an assessment of providers’ compliance programs. The results indicate that providers sometimes fail in relatively less complicated and readily addressable ways. Continue reading » |
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