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Healthcare Vendor Arrangements – Buyer Beware
Physician groups are frequently approached with “business opportunities” that sound routine, such as equipment leases, administrative services agreements, space rentals, and networking events. But all too often, those offers are really just dressed-up referral schemes that can land physicians in trouble. Two recent federal cases are important reminders that when it comes to vendor relationships,…
The New Administrative False Claims Act Enhances Federal Agencies’ Power to Combat Fraud
The Administrative False Claims Act (“AFCA”), previously known as the Program Fraud Civil Remedies Act of 1986 (“PFCRA”) is an infrequently used, but related counterpart to the more well-known False Claims Act (“FCA”). The FCA is a widely used tool by the Department of Justice (“DOJ”) to prosecute false claims and statements in federal courts,…
Are you Checking the PMP Before Prescribing? Pharmacy Board Audits of PMP Data
The Arizona Controlled Substances Prescription Monitoring Program (“PMP”) was established in 2007 and provides the State of Arizona with a central database to track the dispensing of controlled substances. The PMP is designed to assist providers in making better-informed decisions and help “prevent the diversion and misuse of controlled substances at the provider, pharmacy, and…
Emergency Rulemaking Expands AHCCCS’ Exclusion Authority
AHCCCS has broad authority to exclude participating providers from its program. For example, AHCCCS may terminate a provider’s AHCCCS participation agreement if the provider fails to comply with their provider participation agreement, or with federal and state laws, rules, or regulations. AHCCCS must also suspend payments pending an investigation of a “credible allegation of fraud”…
Scrutiny and Regulation of Non-Compete Agreements
On July 9, 2021, President Biden issued an “Executive Order on Promoting Competition in the American Economy.”[1] The Executive Order takes aim at non-compete agreements, and affirms the Biden Administration’s policy “to enforce the antitrust laws to combat the excessive concentration of industry, the abuses of market power, and the harmful effects of monopoly…