Tag Archives: New York

Three Dozen States Sue Makers of Opioid Addiction Treatment Medications for Antitrust

With opioid abuse continuing to dominate national headlines, manufacturers of opioid overdose medications are facing intense scrutiny over pricing practices that threaten (or those perceived as threatening) public availability of these medications.  In March 2015, for instance, Congress investigated “price hikes” by Amphastar Pharmaceuticals, Inc. (“Amphastar”) for naloxone (sold under the brand name Narcan®), a … Continue reading this entry

New York Legislation to Require Payment Parity for Telehealth Services

New York introduced a new bill designed to ensure commercial health plans pay for telehealth services at the same rate the plans pay for in-person services. The legislation, SB 7953, comes on the heels of New York’s long-awaited telehealth coverage law and seeks to add payment parity language to the State’s existing telehealth coverage statute. See … Continue reading this entry

Recent New York Medicaid Settlement with Pharmacy Shows Importance of Checking Excluded Provider List Prior to Filling Prescriptions

A New York pharmacy has agreed to pay approximately $500,000 to the State of New York for improperly billing New York Medicaid for prescriptions written by a physician who had been excluded from the Medicaid program. This settlement serves as an important reminder to all pharmacies operating in New York: Before filling a prescription, pharmacies … Continue reading this entry

Changes to New York Telehealth Coverage Coming Soon

After New York became the 22nd state to enact a telemedicine commercial coverage statute, Governor Andrew Cuomo signed an amendment changing the statute. The amendment makes sweeping changes to telehealth coverage under New York Medicaid and commercial health insurance. With an effective date of January 1, 2016, providers and insurers need to be ready and … Continue reading this entry

Fasten Your Seat Belts: District Court Says “Failure to Act Quickly Enough” May Violate 60-Day Refund Rule

A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which both the federal government and the State of New York have intervened. As important to this discussion, the … Continue reading this entry

State Medicaid Programs May Be Leaving Revenue From Drug Rebates on the Table

The recent release of a New York State Office of the State Comptroller audit report serves as an example of state Medicaid programs that may not be maximizing their collection of revenue from drug rebates for Medicaid managed care enrollees. This report indicated that the New York Medicaid program did not collect as much as $119.3 … Continue reading this entry

Look at What New York Did With Telemedicine to Bring in the New Year

It’s party time in the Big Apple as New York becomes the 22nd state to enact a telemedicine commercial reimbursement statute. The legislation was sponsored by Senator Catharine Young (R) and signed into law by New York Governor Andrew Cuomo (D), representing bi-partisan support to facilitate patient access to telemedicine services through private sector growth … Continue reading this entry

Largest Ever HIPAA Fine Comes Down Hard on Two New York Hospitals

New York-Presbyterian Hospital (NYP) will pay $3.3 million and Columbia University (CU) will pay $1.5 million to settle allegations that they failed to secure thousands of patients’ electronic protected health information (ePHI) held on their network. The monetary payments totaling $4,800,000 are the largest HIPAA settlement to date. In addition to the payment of this significant fine, NYP … Continue reading this entry

New York Office of the Medicaid Inspector General Releases 2014-2015 Work Plan

The New York State Office of the Medicaid Inspector General (OMIG) is the New York State (NYS) Medicaid program’s “watchdog” agency. (Last year they recovered in excess of $851 million from providers and others.) It is one of the most prominent state OMIG’s in the country, so providers in other states keep an eye on what the … Continue reading this entry

Update: Private Investment in Health Care Entities in New York

Despite the New York State Legislature’s second attempt at allowing private equity investment in health care entities, the recently adopted 2014-2015 budget did not include the proposed two-year pilot program that would have established up to five eligible for-profit corporations as owners or operators of hospitals. The program was meant to “assist in restructuring health … Continue reading this entry

New York Reconsidering Private Equity Investment in Health Care Entities

New York State is again considering whether to allow private equity investment in health care facilities after the first proposal to do so was dropped from the 2013-2014 enacted budget due to a lack of support. Gov. Andrew Cuomo’s 2014-2015 budget proposal calls for a two-year pilot program, subject to the Public Health and Health Planning Council’s … Continue reading this entry

Recent Amendments to New York's Not-For-Profit Corporations Law

Time to Update Your Corporate Bylaws? New York Gov. Andrew Cuomo signed the New York Non-Profit Revitalization Act of 2013 (Act), into law in December 2013, thereby adopting important changes to the governance of nonprofit entities that will go into effect on July 1, 2014. The Act attempts to modernize the existing New York Not-for-Profit … Continue reading this entry