Archive of Provider Alerts

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

Denial Codes and Reasons

Fraud and Abuse

While MedStar Family Choice monitors for possible fraud and abuse activities, we need your help to eliminate fraud and abuse. If you know of a situation that may involve fraud and abuse please report it immediately by calling the MedStar Family Choice Compliance Director at 202-448-6764. You may also contact Provider Relations at 202-243-5489 or call the Medstar Health Corporate Integrity Hotline at 877-811-3411. You may remain anonymous and all reports will be kept confidential. In addition, MedStar Family Choice enforces a non-retaliation policy for those individuals reporting possible fraud and abuse.

Fraud and abuse information for DC Healthcare Alliance Members

Fraud and abuse information for DC Healthcare Alliance Providers

Synagis (palivizumab)

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

MedStar Family Choice follows the American Academy of Pediatrics 2014 guidelines for Synagis (palivizumab) administration (see link below). 

Requests for Synagis (palivizumab) require a completed 2016-2017 Synagis® Seasonal Respiratory Syncytial Virus Enrollment Form (see link below). Please fax completed forms to MFC at 202-243-5496.

If you have questions for MFC, call 855-210-6203.

Click here for the American Academy of Pediatrics 2014 Synagis (palivizumab) Guidelines.

Click here for the Synagis (palivizumab) Prior Authorization Form.

Recent Recalls

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

The following medications/products have been recently recalled. Please note that MedStar Family Choice has sent letters to each member affected by these recalls. 

Glucagen® Hypokit®

On September 8, 2016, Novo Nordisk issued a patient-level recall of Glucagen® Hypokit® for Injection NDC # 00169-7065-15. This recall was issued because a small number of needles were detached from the syringe. A syringe with a detached needle cannot be used as prescribed.

Novo Nordisk conducted an investigation which showed that a small number (0.006%) of needles could be detached from the syringe in certain batches of GlucaGen HypoKit. To protect patient safety, Novo Nordisk is recalling affected batches from wholesalers, pharmacies and patients in the United States. It is estimated that out of the 71,215 pens being recalled, four pens could be defective. The affected products were distributed starting February 15, 2016.

The date range for this issue is March 9, 2016 – September 9, 2016.

This recall includes GlucaGen HypoKit lot numbers:

  • FS6X270, Exp. 09/30/2017
  • FS6X296, Exp. 09/30/2017
  • FS6X538, Exp. 09/30/2017
  • FS6X597, Exp. 09/30/2017
  • FS6X797, Exp. 09/30/2017
  • FS6X875, Exp. 09/30/2017

50mm 0.2 Micron Filters manufactured by Baxter Healthcare Corporation

On October 12, 2016, the United States Food and Drug Administration (FDA) issued a notice regarding a Class I recall of 50mm 0.2 Micron Filters Product Code H93835 NDC # 17191-0035-00 manufactured by Baxter Healthcare Corporation. This recall affects all unexpired lots and was issued because due to the potential for the filter membrane layer to be missing and for particulate matter to be present.

Diocto Liquid 50 mg/5 mL

On October 19, 2016, the United States Food and Drug Administration (FDA) issued a notice regarding a Class I Recall of Diocto Liquid 50 mg/5 mL NDC # 00536-0590-85 manufactured by PharmaTech and distributed by Rugby. This recall was issued due to a risk of product contamination with Burkholderia cepacia. Use of docusate sodium liquid contaminated with B. cepacia may result in serious infections that could be life-threatening in patients with compromised immune systems and in patients with chronic lung conditions such as cystic fibrosis. The company learned of the potential issue through the receipt of two isolated complaints regarding this product. FDA has informed PharmaTech and Rugby that it received several adverse event reports of B. cepacia infections in patients. Additionally, some of these reports identify liquid docusate products manufactured by companies other than PharmaTech. The affected lot numbers are as follows:

  • 20351407 09/30/16; 20351408 09/30/16
  • 20351409 11/30/16; 20351410 12/31/16
  • 20351501 01/31/17; 20351502 01/31/17
  • 20351503 03/31/17; 20351504 04/30/17
  • 20351505 05/31/17; 20351506 06/30/17
  • 20351507 06/30/17; 20351508 07/31/17
  • 20351509 10/31/17; 20351510 10/31/17
  • 20351511 11/30/17; 20351512 11/30/17
  • 20351513 11/30/17; 20351601 01/31/18
  • 20351602 02/28/18; 20351603 03/31/18
  • 20351604 04/30/18; 20351605 04/30/18

Hepatitis C Medications

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

Important considerations when prescribing hepatitis C medications:

  • Most patients must have a liver biopsy or other accepted test (e.g., FibroSure) demonstrating a Metavir score >1 (Fibrosure F1-2 range is acceptable). Patients with HIV or HBV co-infection do not require a minimum level of fibrosis (i.e. they may be treated regardless of Metavir score).
  • A baseline viral load must be obtained within 90 days of the anticipated start of treatment.
  • Mandatory virologic testing at 4, 12 and 24 weeks must be performed with the intent to discontinue treatment if there is inadequate viral response (defined in the MedStar Family Choice Hepatitis C Protocol).
  • Initial medication approvals will be for 8 weeks of treatment. Additional medication will be approved only after lab testing is submitted at week 4 (and week 12 for patients in whom regimens extend greater than 12 weeks).

If you wish to prescribe hepatitis C treatment, please complete the Hepatitis C Prior Authorization Form (see link below) and fax it to 202-243-5496. This form will also serve as a prescription that will be forwarded to CVS Caremark Specialty Pharmacy allowing your patient to receive his/her medication. For any questions, please contact Danielle Gerry, MD at 410-933-2295 or Patryce Toye, MD at 410-933-2204.

Click here for the MedStar Family Choice Hepatitis C Protocol.

Click here for the Hepatitis C Prior Authorization Form.

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Medical Policies and Procedures

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Provider Alerts

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >