Pharmacies and pharmacy benefit managers have had a business relationship with each other since the 1960s. Today, PBMs function as intermediaries between insurers, drug manufacturers, and pharmacies. Because they do so much within the industry, it is logical for them to charge fees for revenue. These include GER and DIR fees, which affect pharmacies in […]
The Department of Health and Human Services Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the Stark Law, Anti-Kickback Statute, and Civil Monetary Penalty Law in 2019. The changes clear up issues with the Stark Law and Anti-Kickback Statute as well as offer new exceptions […]
When it comes to DME and HME regulations, documentation can be one of the most frustrating aspects of compliance. If suppliers don’t show proper documentation for the necessity of providing an item, there can be serious repercussions with CMS. What happens when documentation isn’t complete? Compliance issues aren’t always about fraud or abuse. Sometimes, a […]
The Drug Enforcement Administration (DEA) is helping to fight the opioid crisis by revoking controlled substance registrations from pharmacies, pharmacists, and prescribers under 21 U.S.C. § 824. The DEA revived this practice in 2018. It allows them to prevent suspect pharmacists, pharmacies, and prescribers from dispensing or prescribing federally controlled substances. In order to avoid […]
The Stark Law refers to a federal law that regulates how doctors can make referrals for certain items or services provided to Medicare and Medicaid patients. The Stark laws were named for Congressman Pete Stark, the original legislator who sponsored the first of the three bills implementing the law. The purpose of Stark Law is […]
Home health and hospice agencies must follow a large number of compliance laws along with staying in business. Having a good understanding of some of the biggest laws can help you and your staff stay up-to-date on compliance. Compliance laws and issues for home health agencies One of the biggest compliance laws for home health […]
Any business that handles healthcare is in a unique position where they must blend business with providing medical care. The sensitive nature of the industry makes it one of the most regulated in the United States. It is vital for any healthcare operation to understand the laws that have been created to help guide them […]
