Archive for December 2020
Supreme Court Rules Against Pharmacy Benefit Managers, Scoring a Win for Independent Pharmacies
The U.S. Supreme Court recently ruled against Pharmacy Benefit Managers (PBMs), scoring a win for smaller, independent pharmacies. The opinion by the high court will allow states to regulate how much money PBMs are required to reimburse pharmacies for prescription medication. On December 10, 2020, in Rutledge v. Pharmaceutical Care Management Assn., the Supreme Court…
Read MorePharma Giant Pays $22M to Settle Alleged Kickback Scheme Involving Charitable Foundations
Pharma giant Biogen Inc. has become the most recent company to resolve allegations that it violated the False Claims Act by illegally using two charities to pay the co-pays of Medicare patients taking its multiple sclerosis drugs, Avonex and Tysabri. The U.S. Department of Justice announced earlier this month that the Cambridge, Mass.-based company agreed…
Read MoreHHS Proposes Revisions to HIPAA Privacy Rule
The U.S. Department of Health and Human Services Office for Civil Rights (OCR) is seeking to revise the HIPAA Privacy Rule, a move it says will “remove barriers to coordinated care, and reduce regulatory burdens on the health care industry.†The proposed rule changes are part of HHS’ “Regulatory Sprint to Coordinated Care.†Among some…
Read MoreOIG to Recover $4B in 2020 Resulting From Investigative Efforts
The U.S. Department of Health and Human Services Office of Inspector General recently reported that it expects to recover more than $4 billion in misspent Medicare, Medicaid and other HHS dollars as a result of its investigative efforts. While that is a lot of money, it is considerably less than the nearly $5.9 billion the…
Read MoreHHS, CMS Announce Changes to Stark Law and Anti-Kickback Statute
The U.S. Department of Health and Human Services Office of Inspector General and Centers for Medicare & Medicaid Services recently published long-awaited final rules that significantly reform regulations interpreting the federal Stark Law and Anti-Kickback Statute. The agencies have stated that the changes “aim to reduce regulatory barriers to care coordination and accelerate the transformation…
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