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Health Law Blog

This blog is devoted to current legal and regulatory issues affecting health care providers in New York, New Jersey and nationally. We regularly publish on topics of interest to doctors, pharmacists, hospital administrators, and everyone who is interested in the current developments in the legal landscape affecting health care delivery today.

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18
Dec
0

Healthcare Providers Responsible for Billers' Violations of Federal and State Laws

Posted by on in News and Announcements
All healthcare providers are advised that pursuant to Section 6503 of the Federal Patient Protection Affordability Care Act (“PPACA”), all providers using third party billing companies or agencies to submit claims to Medicaid on their behalf are responsible for ensuring that those companies are properly registered and compliant with the NYS Medicaid Program as per the regulations promulgated by the Office of Medicaid Inspector General ("OMIG"). Since February 2011, OMIG has made a list of the currently enrolled billing service agencies available for general public on its website. 

To comply with the law, medical billing service companies must be registered with Medicaid and disclose their fee schedules arrangements. Despite popular belief and common practice, NYS law prohibits fee-splitting between medical practitioners and third parties. Therefore, billing/collection service agreements based on a percentage of the amount billed, collected, or any formula based on actual collections are improper. The only permitted billing collection service payment arrangement is one based on the cost and processing of the bills.

It should be noted that, as Medicaid registrants billing&collection companies are increasingly targeted for audits by the OMIG. This means that healthcare providers and billers should follow the OIG Compliance Program guidance for Third Party Medical Billing companies to make sure they do not violate any federal or state laws.

If you have any questions or need legal guidance in connection with billing service agreements or any other legal questions, please feel free to contact an experienced healthcare attorney by phone at 718-787-9500 or email at This email address is being protected from spambots. You need JavaScript enabled to view it. .

 
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20
Oct
0

NY Medicaid Providers - Compliance Deadline is Approaching!

Posted by on in News and Announcements
FOR A LIMITED TIME ONLY, WE ARE OFFERING A DISCOUNT OF $250 ON OUR COMPREHENSIVE COMPLIANCE PACKAGES FOR HEALTHCARE PROVIDERS


If you are a HEALTH CARE PROVIDER IN THE STATE OF NEW YORK, you MUST BE AWARE that every healthcare provider billing or ordering over $500,000 per year from the NYS Medicaid program (including claims billed indirectly through third-party managed care organizations (“HMOs”) is required to adopt and implement an effective compliance program.  The requirement pertains to services billed directly by the provider as well as any indirect claims such as orders or referrals for ancillary services, claims for which are submitted to Medicaid, including but not limited to laboratory, radiology, and ambulette services. The Compliance Program applies to billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing, staffing and other risk areas that are or should, with due diligence, be identified by every healthcare provider.

All providers are cautioned: A provider may be subject to sanctions and penalties, including revocation of enrollment in the NYS Medicaid Program, for failing to implement an adequate compliance program.  Putting together a Compliance Program that meets the requirements of the NYS Department of Health and the Office of Medicaid Inspector General involves a comprehensive professional review of your operations and compiling an extensive set of requisite documentation.

The NYS Medicaid Compliance Program must satisfy specific requirements set forth in relevant NYS codes and regulations.  When applying for initial provider enrollment in the NYS Medicaid program, in transfer of ownership applications and once per year thereafter, during the month of December, every NYS healthcare provider must demonstrate and certify to the Office of the Medicaid Inspector General that an adequate and effective Compliance Program has been implemented, which includes properly drafted policies and procedures that describe compliance expectations. 

December 2012 is an IMPORTANT DEADLINE!! Every NYS healthcare provider claiming over $500,000 per year must CERTIFY to OMIG that an adequate Program is in place by DECEMBER 31, 2012!

Experienced attorneys at the healthcare law firm of Sauchik Law Group, P.C. will take time to address any of your questions pertaining to implementation and certification of an effective Medicaid Compliance program as well as address any other healthcare legal issues you may be facing. 

CALL US today at 718-787-9500, visit our website at ww.mdrxlaw.com or email us at This email address is being protected from spambots. You need JavaScript enabled to view it.



Tagged in: compliance Medicaid news Pharmacy
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20
Oct
0

Medicaid Compliance Deadline is Fast Approaching

Posted by on in News and Announcements
FOR A LIMITED TIME ONLY, WE ARE OFFERING A DISCOUNT OF $250 ON OUR COMPREHENSIVE COMPLIANCE PACKAGES FOR HEALTHCARE PROVIDERS


If you are a HEALTH CARE PROVIDER IN THE STATE OF NEW YORK, you MUST BE AWARE that every healthcare provider billing or ordering over $500,000 per year from the NYS Medicaid program (including claims billed indirectly through third-party managed care organizations (“HMOs”) is required to adopt and implement an effective compliance program.  The requirement pertains to services billed directly by the provider as well as any indirect claims such as orders or referrals for ancillary services, claims for which are submitted to Medicaid, including but not limited to laboratory, radiology, and ambulette services. The Compliance Program applies to billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing, staffing and other risk areas that are or should, with due diligence, be identified by every healthcare provider.

All providers are cautioned: A provider may be subject to sanctions and penalties, including revocation of enrollment in the NYS Medicaid Program, for failing to implement an adequate compliance program.  Putting together a Compliance Program that meets the requirements of the NYS Department of Health and the Office of Medicaid Inspector General involves a comprehensive professional review of your operations and compiling an extensive set of requisite documentation.

The NYS Medicaid Compliance Program must satisfy specific requirements set forth in relevant NYS codes and regulations.  When applying for initial provider enrollment in the NYS Medicaid program, in transfer of ownership applications and once per year thereafter, during the month of December, every NYS healthcare provider must demonstrate and certify to the Office of the Medicaid Inspector General that an adequate and effective Compliance Program has been implemented, which includes properly drafted policies and procedures that describe compliance expectations. 

December 2012 is an IMPORTANT DEADLINE!! Every NYS healthcare provider claiming over $500,000 per year must CERTIFY to OMIG that an adequate Program is in place by DECEMBER 31, 2012!

Experienced attorneys at the healthcare law firm of Sauchik Law Group, P.C. will take time to address any of your questions pertaining to implementation and certification of an effective Medicaid Compliance program as well as address any other healthcare legal issues you may be facing. 

CALL US today at 718-787-9500, visit our website at ww.mdrxlaw.com or email us at This email address is being protected from spambots. You need JavaScript enabled to view it.



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02
May
0

Pharmacy Circle Membership - An Attorney Always by Your Side

Posted by on in News and Announcements
Complimentary PharmSupportPlus Membership

We are inviting you to try an exclusive membership plan for pharmacies

With this unique service you can:
  • Access our online private support area - ask our attorneys and business consultants any questions related to your business and receive clear and on-point answers fast
  • Chat live with our attorneys and business consultants
  • Use our 24/7 toll-free number for members only
  • Perform background verification and criminal records searches
  • Subscribe to InfoWatch - pharmacy information monitoring, license expiration watch and necessary updates with NPI, NCPDP and Board of Pharmacy
  • Access our collection of essential pharmacy documents and frequently asked questions
  • Post a question to our public discussion area
  • Retrieve member-only coupons and discounts from pharmacy vendors
  • Receive substantial discount on legal services (to our paid members)
A screenshot of our member-only area:

members

To become a member, please Click Here
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05
Apr
0

Chain Pharmacy Price Estimates

Posted by on in News and Announcements
Weoffer are able to give you an estimate of how much a chain pharmacy will pay for your store in just minutes!  Submit your information by filling out this simple form and we will contact you to discuss the potential valuation and the process.  There are no obligations on your part, and your information will be treated with strict confidentiality. 
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