Insights & Resources

On March 9, 2024, CMS announced it will make available Change Healthcare/Optum Payment Disruption accelerated payments to providers experiencing potentially significant cash-flow problems as a result of the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare/Optum .

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (23-15) permitting a consulting company’s (Consultant) proposal to offer gift cards to its current physician practice customers for referring potential new physician practice customers to Consultant.  Notably, OIG determined that the proposed arrangement did not implicate the Anti-Kickback Statute (AKS). 

The New York State Office of the Medicaid Inspector General (OMIG) released its 2024 work plan in furtherance of its mission to coordinate and conduct activities to prevent, detect and investigate medical assistance program fraud, waste and abuse, and to recover improperly expended Medicaid funds.  

Continuing its year-end reporting blitz, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 1, 2023. 

This week, the United States Department of Justice (DOJ) and the United States Department of Health and Human Services (HHS) fulfilled its annual statutory obligation by releasing its jointly-authored Health Care Fraud and Abuse Control Program (HCFAC) Report for Fiscal Year 2022.

The OIG fulfilled its annual statutory obligation by releasing its Top Management and Performance Challenges (TMC) document. Providers should take note because the document provides important insight into the specific areas over which HHS (and the OIG) will remain focused.  

In this article published in the New York City Pharmacists Society Newsletter, Stacey Gulick highlights some of most significant, and perhaps unexpected, issues that must be addressed by pharmacists in their ongoing HIPAA compliance efforts. 
 

On November 6, 2023, the OIG released its General Compliance Program Guidance, the first in a series of new, non-binding reference guides designed to share information with health care compliance professionals and other health care industry stakeholders

In what appears to follow a multi-state trend to protect “temporary” workers, as part of the New York Budget for FY 2023-2024, a new law went into effect that requires any entity that provides temporary staff to health care entities to register with the Department of Health (DOH). 

On April 6th, 2021, the New York legislature announced that it was delaying, for two years, a controversial policy that would require the New York Medicaid program to shift payment of most drugs from Medicaid Managed Care (MMC) to Fee-For-Service (FFS) reimbursement. In New York, claims submitted by providers that participate in the 340B Drug Pricing Program (340B Program) and paid under FFS are reimbursed at actual acquisition cost, whereas 340B Program claims paid under MMC are based on the Pharmacy’s contract with the MMC plan.

The New Jersey Health Care Transparency Act (the “Act”) becomes effective on July 1, 2021. The Act requires health care professionals to clearly inform patients of their training and qualifications when they are providing in-person care to patients and when advertising their practice.

Last year, New York State approved the transition of the Medicaid pharmacy benefit, from managed care (MMC) back to fee-for-service (FFS). The effective date of that transition has been postponed for one month, to May 1, 2021.

On November 16, 2020, the U.S. Department of Health and Human Services, Office of the Inspector General (the “OIG”) issued a Special Fraud Alert (“SFA”) emphasizing the fraud and abuse risks inherent in speaker programs run by pharmaceutical and medical device companies.

Garfunkel Wild’s Andrew Zwerling, Marianne Monroy, Salvatore Puccio, and Lauren Levine will present the webinar  “An Employer’s Practical Guide To Facing Day-To-Day Coronavirus Challenges” on April 20, 2020.

Garfunkel Wild Partner/Director Jeffry Adest and Partner Barbara Knothe will present the webinar “340B Contract Pharmacy Issues for FQHCs” on March 4, 2020.

Stacey Gulick will present at Monroe County Medical Society Webinar Survival Series: HIPAA Webinar on September 26, 2019.

John G. Martin and Robert A. Del Giorno will present at the Nassau County Bar Association’s CLE – Recent Trends in Health Care Fraud Investigations on September 17, 2019.

Andrew Blustein was selected as an instructor at the Horizon Foundation for Webinar, “Do No Harm: Exploring Strategies FOR Safer Prescribing Of Opioids.”

Marianne Monroy and Salvatore Puccio will present at the FCMA’s Webinar – Navigating Sexual Harassment in the Workplace for Managers & Supervisors on May 9, 2019.