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By: Jeffrey S. Baird, Esq. Many pharmacies work with skilled nursing facilities (“SNFs”) and custodial care facilities (collectively referred to as “Facilities”). A Facility is a “referral source” to the pharmacy. Even though the Facility may give “patient choice,” if the pharmacy dispenses a drug to a Facility patient, the law considers the patient to […] More...

By: Jeffrey S. Baird, Esq. In a June 16, 2017 article in the Harvard Business Review entitled “Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes,” David J. Bailey, M.D. (President/CEO of Nemours Children’s Health System) stated: “Despite spending twice what other developed nations spend on a per capita basis for healthcare, the […] More...

By: Jeffrey S. Baird, Esq. Generally, federal law prohibits healthcare providers from employing or contracting with individuals that are excluded from participation in federal healthcare programs (“Excluded Individuals”). Excluded Individuals can include persons convicted of crimes. Excluded Individuals While CMS does not prohibit a healthcare provider from ever hiring a convicted felon, there are specific […] More...

By: Jeffrey S. Baird, Esq. Introduction Historically, governmental regulatory agencies have not been overly aggressive in bringing enforcement actions against pharmacies under the Medicare anti-kickback statute, state anti-kickback statutes, and other anti-fraud laws. This is changing for a number of reasons. First, because pharmacies are billing a number of government healthcare programs (Medicare, Medicaid, TRICARE, […] More...

By: Jeffrey S. Baird, Esq. The U.S. Department of Justice (“DOJ”) and the Office of Inspector General (“OIG”) have become much more aggressive in bringing civil and criminal investigations against pharmacies and their owners. Many investigations are a result of qui tam (whistleblower) lawsuits. This is when a disgruntled ex-employee, disgruntled current employee, or any […] More...