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Monthly Round-Up of What to Read on Pharma Law and Policy

Bill of Health

Coverage of New Drugs in Medicare Part D. J Am Pharm Assoc (2003). Naci H, Kyriopoulos I, Feldman WB, Hwang TJ, Kesselheim AS, Chandra A. 2022 May 3. Epub ahead of print. Suda KJ, Kim KC, Hernandez I, Gellad WF, Rothenberger S, Campbell A, Malliart L, Tadrous M. 2022 May-Jun;62(3):766-774.e6. Epub ahead of print.

FDA 205
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Physicians Beware! Groups Providing DME, Prosthetic Devices, and Other Medical Supplies to Their Medicare Patients Risk Violating the Strict Liability Stark Law Since the Expiration of COVID-19 Public Health Emergency

Health Law Advisor

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

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DIR Reform: what you need to know

Natalia Mazina

DIR fees were implemented with the creation of the Part D program through the passage of the Medicare Modernization Act of 2003. 2 As of 2018, DIR fees have increased to over six percent of the overall Medicare drug sales. There are three coverage phases in a Medicare recipient’s drug design.

Medicare 137
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Proper Payments for Part B and Part D Drugs

Innovaare Compliance

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

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WHOOP and the IRS: How Tax Avoidance Helps Health

Bill of Health

Bush introduced HSAs by signing into law the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. On the contrary, FSAs allow both, giving employees greater say in how much tax-advantaged dollars go toward their care. A quarter of a century after FSAs were introduced, President George W.

Doctors 111
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HHS-OIG Excludes Theranos Founder and CEO from Federal Health Programs for 90 Years

HIPAA Journal

The Theranos Scandal Theranos was a blood testing startup founded by Elizabeth Holmes in 2003. The HHS-OIG has the authority under 1128(a) of the Social Security Act to exclude individuals from participation in Medicare, Medicaid, and other Federal health care programs.

Fraud 70
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Part 2: Understanding How Payers Deny Claims

AIHC

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?