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After the claims adjudication process is complete, the insurance company often sends a letter to the person filing the claim describing the outcome. The letter, which is sometimes referred to as remittance advice, includes a statement as to whether the claim was denied or approved. If the company denied the claim, it has to provide an ...
For example, Purdue Pharmaceuticals entered an agreement with the United States, pleading guilty to felony misbranding of OxyContin with intent to defraud and mislead under sections 33 1(a) and 333(a)(2) of the FD&C Act and agreed to pay more than $600 million, but only $160 million was allocated to resolve civil claims under the False Claims ...
Legal claims against the pharmaceutical industry have varied widely over the past two decades, including Medicare and Medicaid fraud, off-label promotion, and inadequate manufacturing practices. [ 3 ] [ 4 ] With respect to off-label promotion, specifically, a federal court recognized off-label promotion as a violation of the False Claims Act ...
A Florida-based specialty pharmacy will pay $3.5 million to resolve allegations it served as a conduit for a Teva Pharmaceutical Industries Ltd subsidiary to pay kickbacks to Medicare patients ...
Healthcare services provided include: pharmacy management, electronic medical records, claims adjudication, as well as mental and behavioral health programming. [ 11 ] Inpatient and Residential Treatment Facilities
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Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2] Express Scripts had 2016 revenues of $100.752 billion. [2]
A CVS Pharmacy location in California. The Federal Trade Commission says that healthcare conglomerates such as CVS, UnitedHealth and Cigna are finding new ways to raise prices on prescription drugs.