Legal & Business Advice

Expert Legal & Business Advice

Amanda G. Fields, APRx General Counsel

Picture of Amanda C. Fields

   

Roger Buchhorn, CPA

Audit Protection Forms

 

 

 



Highlights of the New HIPAA Regulatory Provisions (download)

By Amanda G. Fields, General Counsel for American Pharmacies

The U.S. Department of Health and Human Services (DHHS) has issued wide-ranging changes to HIPAA rules, in part to flesh out changes to the HIPAA Privacy and Security Rules made by the Heath Information Technology for Economic and Clinical Health Act (HITECH). Many of these new rules take effect September 23, 2013. Major changes include lowering the standard for what constitutes a security breach and subjecting subcontractors to HIPAA regulations; minor changes include allowing an individual to request protected health information sent to a third party. 


Use TDI as Your Dispute Adjudicator (download)

By Amanda G. Fields, General Counsel for American Pharmacies

American Pharmacies continues to work closely with the Texas Department of Insurance (TDI) to help independent pharmacies submit and resolve complaints against health maintenance organizations, insurers and the PBMs they contract with to process and pay claims. Learn more about how the outreach efforts of TPBC's staff and consultants have helped improve the complaint process for you.


Complaints Made Against You to TSBP (download)

By Amanda G. Fields, General Counsel for American Pharmacies

Anyone may file a complaint with the Texas State Board of Pharmacy against a pharmacy or pharmacist. Some complaints are dismissed, referred to another agency or closed with a verbal or written warning. But others may trigger investigations and complex disciplinary proceedings that could result in fines or the suspension or revocation of a pharmacist's/pharmacy's license. If you or your pharmacy is the subject of a complaint filed with the TSBP, it is vital that you understand the nature of the agency's disciplinary proceedings and your rights under the process.

 


The Independent Pharmacist's Duty to Warn (download)

By Amanda G. Fields, General Counsel for American Pharmacies

As the pharmacist's role has evolved from dispensing medications to providing patient counseling services and health-care-medical advice, so has your accountability, particularly in regard to the pharmacist's duty to warn (DTW). Under the DTW theory of liability in medical malpractice lawsuits, patients injured by prescription drugs claim that the pharmacist has a DTW about the potential adverse effects and dangers associated with the drugs.


Auditing Loopholes in Medicare Part D  

By Amanda G. Fields, General Counsel for American Pharmacies

You are often at the mercy of insurance companies, the PBMs they hire and third-party administrators. One essential area where pharmacists are targeted most financially is audits, whether an unlawful notification of an on-site audit or an erroneous demand for chargebacks. Rather than fight the audit, many pharmacists simply forfeit deserved reimbursement. You should be aware of a recent ploy involving an auditing loophole in Medicare Part D.

 

 


Firing Tips For The Independent Pharmacist  

By Amanda G. Fields, General Counsel for American Pharmacies

The termination of a bothersome employee may seem like an easy decision, but a firing  can have longterm repercussions for a small business. A difficult employee can become a difficult adversary after being fired.

Wise employers follow sound policies procedures in terminating employees, which will reinforce the decision to fire an employee and help preclude future legal action for wrongful termination. It is important to follow sound procedures when firing an employee to avoid wrongful termination and other employment-related lawsuits.


Hiring Tips For The Independent Pharmacist  

By Amanda G. Fields, General Counsel for American Pharmacies

A pharmacy is only as successful as the people it employs. Similarly, bad employees can cost a pharmacy an incredible amount of time, money and resources. It pays to invest significant time in the hiring process to pinpoint the best candidate for the vacant position at your pharmacy. Learn more about useful strategies you should implement in your hiring process.


Your Guide to the On-Site Audit & the New Audit Reform Law  

By Amanda G. Fields, General Legal Counsel for American Pharmacies

Audits by insurance companies, PBMs and third-party payers are a major threat to the practice and business of pharmacy. Too often, the on-site audit is simply a mechanism to recoup thousands of dollars, frequently from small independent pharmacies.

Once an insurance company or PBM has conducted an on-site audit, it typically notifies the pharmacy that it will recoup money by taking out payments from future money due. Many pharmacies give up a reimbursement just to continue the “privilege” of doing business with their tormentor.

It is imperative that you take steps to prevent audits, understand your rights under Texas law, voice opposition to unlawful audits and appeal any demands for recoupment. This guide provides useful tips on handling the on-site audit.


Contract TIPS for the Independent Pharmacist  

By Amanda G. Fields, General Legal Counsel for American Pharmacies

Contracts are a critical part of doing business for any independent pharmacy. Contracts cover a variety of pharmacy business relationships ranging from drug wholesalers and PBMs to merchandise distributors and service providers. Knowing how to avoid bad contracts and how to successfully negotiate good ones is critical to the success of your business.


 

Safeguard Your Business from Employee Fraud  

By Roger Buchhorn, CPA

According to the Association of Certified Fraud Examiners, businesses employing fewer than 100 persons are the most vulnerable to fraud and abuse by employees. There is generally a closer relationship between the owner or managers and their employees, and financial controls within smaller businesses are generally more casual or even nonexistent.

Surprisingly, many owners take few precautions because they do not believe it is an issue in their organization. An owner must understand and accept the possibility of fraud within the business in order to prevent it.