Caremark Settles False Claims Act Allegations

On Friday, the U.S. Department of Justice announced that Caremark, LLC will pay $6 million to settle allegations under the False Claims Act.  The U.S. government alleged that Caremark knowingly failed to reimburse Medicaid for prescription drug costs who also were eligible for coverage under Caremark private health plans. The government alleged that Caremark’s RxCLAIM computer platform allegedly failed to pay the full amount due on certain claims because it improperly deducted certain co-payment or deductible amounts when calculating payments. … Read More >

Medical Records Worth More Than Credit Cards to Hackers

Following the data breach at Home Depot, Reuters reported that medical information is worth ten times more than credit card information on the black market.  Just last month Reuters reported on an FBI Flash alert to the healthcare industry about hackers targeting the industry.  This followed the hacking of Community Health Systems, resulting in the breach of 4.5 million patient records. According to the Reuters article, because medical identity theft is not generally immediately identified, the use of names, birth… Read More >

OIG Warns Pharmaceutical Manufacturers and Pharmacies About Drug Copayment Coupons

The HHS Office of Inspector General released a Special Advisory Bulletin regarding pharmaceutical manufacturer copayment coupons, and the potential violations of the anti-kickback statute and False Claims Act when such coupons are used to fund copayments for drugs paid for by Medicare Part D.   The anti-kickback statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward the referral or generation of business reimbursable by any Federal health care program…. Read More >

What is the Difference Between NPI and PTAN Numbers?

The Centers for Medicare & Medicaid Services (CMS) recently updated its MLN Matters SE1216 which examines the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN). According to CMS, the NPI is different from a PTAN in the following ways: A provider’s NPI is issued by the National Plan and Provider Enumeration System, which was developed by CMS to comply with the HIPAA Administrative simplification provisions for standard transactions. It is used by all health… Read More >