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An Overview Of Staying Compliant With Stark Law

The Stark Law is a federal law that prohibits doctors from engaging in “self-referrals.” A self-referral occurs when a doctor orders a designated health service that is payable by Medicaid or Medicare and that service is provided by an entity with which the physician has a financial relationship. For example, unless an exception to the […] More...

How To Prepare To Sell Your Pharmacy

Choosing to sell your pharmacy is an important decision. Your business is the culmination of years of work and sacrifice. It is an understandably difficult choice to make, but one that all business owners will likely face. Whether you are selling because you received an offer you cannot refuse or you are moving on to […] More...

ALJ Backlog: Latest Development

By: Jeffrey S. Baird, Esq. The current administrative appeals process is beyond unfair to DME suppliers. A supplier will get hit with a post-payment audit involving multiple patients. The auditing contractor will look for reasons to deny the claims and seek recoupment. The contractor will send a recoupment letter to the supplier … and then […] More...

The “60 Day Rule”

By: Jeffrey S. Baird, Esq. Section 6402 of the Affordable Care Act states that any provider that receives an overpayment from a government healthcare program must (i) report to CMS and (ii) provide written notice of the reason for the overpayment. The overpayment must be reported and returned no later than 60 days after it […] More...

Collaboration With Hospitals to Prevent Readmissions

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...

FDA Inspection: How to Respond

By: Jeffrey S. Baird, Esq. Introduction Until the 1930s, pharmacies were subject to very little government oversight. Beginning in the first half of the 20th century, particularly with the advent of the Food and Drug Administration and the Drug Enforcement Administration, the federal government began to take an increasing role in regulating pharmacies. There are […] More...

Telehealth Arrangements: Continued Scrutiny

By: Jeffrey S. Baird, Esq. Over the past four years, there has been a noticeable growth in the orthotics market. The reasons for this growth are: (i) orthotics are not covered by competitive bidding; (ii) Medicare has historically paid well for orthotics; and (iii) it is relatively easy for a DME supplier to ship orthotics […] More...

Dos and Don’ts of Marketing

By: Jeffrey S. Baird, Esq. The lifeblood of the successful pharmacy is an innovative marketing program. In implementing a marketing program the pharmacy must adhere to multiple federal anti-fraud laws. This article discusses what those laws are, how marketing programs can be properly structured, and what types of marketing programs must be avoided. Federal Anti-Fraud […] More...

Government Scrutiny and Qui Tams

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 DME suppliers and their owners. Many investigations are a result of qui tam (whistleblower) lawsuits. This is when a disgruntled ex-employee, disgruntled current employee, or […] More...