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FAQs About Patients Paying Cash For DME

Suppliers with insurance contracts need to understand how those contracts impact cash sale transactions. To help suppliers avoid legal landmines while navigating the DME cash-pay landscape, health law attorneys Jeffrey Baird and Lisa Smith presented a free webinar on August 2, 2017. Set out below are select questions and Brown & Fortunato’s answers, as well […] More...

Competitive Bidding Round 2019

By: Jeffrey S. Baird, Esq. On January 31, 2017, CMS announced plans to consolidate all rounds and areas included in the Competitive Bidding Program (“Program”) into a single round of competition – Round 2019. After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competition conclude on December 31, 2018, Round 2019 contracts […] More...

Accountable Care Organizations: From Basics to the Next Generation

By: Rossanna J. Madrigal, Esq. The term Accountable Care Organizations (“ACOs”) was formally defined by the Affordable Care Act (“ACA”) in 2010. ACOs are defined as “a legal entity that is recognized and authorized under applicable State, Federal, or Tribal law, is identified by a Taxpayer Identification Number (TIN), and is formed by one or […] More...

Failure to Repay Medicare: Effect on Affiliated Company

By: Jeffrey S. Baird, Esq. Assume that ABC Medical Equipment, Inc. (“ABC”) is 100% owned by John Smith. Assume that Smith also owns 50% of XYZ Medical Equipment, Inc. (“XYZ”) and 25% of DEF Medical Equipment, Inc. (“DEF”). Lastly, assume that, pursuant to a series of aggressive audits, ABC gets hit with recoupment demands that […] More...

Hospital Loan Closet: Legal Basis to Bill Part B

By: Jeffrey S. Baird, Esq. It is a common practice for a DME supplier to enter into a loan closet arrangement with a hospital. This is also known as a “consignment” or “stock and bill” arrangement. In a typical loan closet arrangement, the supplier stores inventory (e.g., canes, walkers, braces) at the hospital. When a […] More...

Utilization of a Marketing Company: Kickback Risks

By: Jeffrey S. Baird, Esq. In the real world, it is common for a business (auto parts supplier, widget company) to “outsource” marketing to a marketing company. The marketing company generates business for the widget company, the widget company pays commissions to the marketing company, and everybody is happy. Unfortunately, pharmacies are not in the […] More...

Paying Physicians: Guidance From Two Cases

By: Jeffrey S. Baird, Esq. Within certain legal parameters, a pharmacy can make payments to physicians. For example, if the pharmacy and physician enter into a legitimate Medical Director Agreement, then the pharmacy can make payments to the physician. Likewise, if a physician will provide bona fide education services for the pharmacy, then the pharmacy […] More...

The Differences Between Litigation And Arbitration

People tend to avoid civil litigation at all costs because it can be expensive, time-consuming, and hard to predict. No one is certain of the outcome until the foreman of the jury hands the paper to the judge, who will read the decision out loud. Today, many use alternative ways to settle a dispute, such […] More...

Legal Issues When Selling A Pharmacy In An Asset Sale

Selling a pharmacy is a complex venture that requires several factors to be completed before a deal is officially made. It is best to enlist the aid of an attorney so the sale can move smoothly. A sale of this nature may require a significant amount of time to complete. You should build a solid […] More...

Healthcare Fraud: Compliance With The Stark Law

Healthcare fraud is a significant problem for the Federal government. The government funds medical care for vast numbers of people, but Federal agencies that review claims for services are constrained by budget restrictions that make it difficult to properly reviewing each claim. To protect Medicare and Medicaid, the two largest healthcare programs in the country, […] More...