(Reuters)—Kentucky Attorney General Andy Beshear said on Thursday he had launched an investigation into allegations that pharmacy benefit managers (PBMs) had overcharged state health insurance programs for drugs and discriminated against independent pharmacies. The investigation comes against the backdrop of widespread criticism of rising costs of prescription medicines in the United States, with PBMs, middlemen…
Ohio Accuses UnitedHealth’s OptumRx of Drug Overcharges
(Reuters)—Ohio’s attorney general on Monday said he had filed a lawsuit against UnitedHealth Group Inc’s OptumRx unit, saying the pharmacy benefit manager had overcharged the state nearly $16 million for prescription drugs. Ohio Attorney General Dave Yost’s lawsuit followed a probe into the extent pharmacy benefit managers (PBMs) like OptumRx had engaged in pricing practices…
U.S. Judge Throws Out Maryland Bid to Protect Obamacare
WASHINGTON (Reuters)—On Feb. 1, a U.S. judge threw out the state of Maryland’s bid to protect the healthcare law, known as Obamacare, in a ruling that also sidestepped a decision on whether President Donald Trump’s appointment of Matthew Whitaker as acting attorney general was lawful. In a win for the Republican president, Baltimore-based U.S. District…
The Eliminating Kickbacks in Recovery Act of 2018—What Does It Mean?
It should not be a surprise to anyone that the U.S. is facing a national opioid crisis. It may be a surprise, however, that the federal government recently passed a law to address this crisis—a law that may have a profound impact on many healthcare facilities, some of which are not involved in the substance…
Ethics Forum: When & How to Intervene with the Impaired Colleague
You are seeing a hospital consult late in the afternoon on a Saturday. The patient has suspected, new-onset lupus with inflammatory arthritis, renal failure with nephrotic range proteinuria and a malar rash. You plan to start the patient on high-dose IV steroids, and you decide to speak to the nephrologist on call first. When he…
Is Concierge Medicine Right for Your Practice?
It is no surprise to practicing physicians that the healthcare landscape is becoming more and more unpredictable. Because of the volatility surrounding today’s healthcare environment, such as increasing overhead costs and decreasing reimbursement rates, many physicians are asking themselves whether there is a different, more lucrative way to practice medicine. Concierge medicine may just be…
Compliance Means More than Just Paperwork
Effective management of healthcare compliance requires an office compliance plan that stays current with changing government regulations, payer requirements, office operations and technology. Many still wonder, why is a compliance program needed—if something isn’t broken, don’t fix it, right? This is not always the case; compliance is an essential part of practice operations, but providing…
Different Payer Audits Require Different Preparation & Response
For a provider of healthcare services, payer audits are always a possibility. Both government and private payers consistently monitor providers to prevent fraud, overpayment, and improper billing or coding procedures. Audits can be nerve-racking and intimidating, even if a provider is billing correctly. Improper billing can lead to civil and criminal sanctions. To alleviate some…
A Guide to Understanding Physician Compensation Models
Understanding your compensation is critical before you decide to accept a job. In the world of medical practices or groups, however, this understanding is even more essential, because a wide variety of compensation structures for physicians exists. These compensation models can dictate not only what a physician will make in the near future, but also…
The Battle with Insurance Companies to Obtain Prescriptions
If you are a news junkie, then you know that a tick-tock is a story that relies heavily on chronology, counting down the events of the day, in order, as inexorably as the ticking clock. These types of timeline stories have become very popular in the fast-paced world of modern politics, in which readers eat…
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