Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
The Personal Services and Management Contracts Safe Harbor
Six standards govern personal services and management contracts under the Anti-Kickback Statute, and missing one voids protection entirely.
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Reading Medicare CARC and RARC Codes in Audit Denials
A Medicare remittance advice denial carries CARC and RARC codes that determine whether a claim needs a correction or a formal appe…
Florida Board of Pharmacy Discipline for Pharmacists and Pharmacies
Florida Board of Pharmacy discipline runs from a signed complaint through a probable cause panel to an administrative complaint, t…
PAMA Clinical Laboratory Fee Schedule Reporting and Audit Risk
PAMA requires many clinical laboratories to report private payor rates to CMS, and reporting errors carry civil penalties and audi…
Hospital Peer Review Actions and Reports to the Licensing Board
How a hospital peer review action against a physician's privileges triggers an NPDB report and a board case, and how the fair hear…
The In-Office Ancillary Services Exception Explained
The Stark Law exception that lets physicians bill in-house imaging and labs has three prongs, and failing one makes every referral…
DEA Questions About Cash Payments and Distance Traveled
Why DEA treats cash payment and long-distance travel as red flags for controlled substance prescriptions, and how to document reso…
DEA Registration for Med Spas and Wellness Clinics
Med spas and wellness clinics that administer Schedule III to V drugs may need their own DEA registration, with medical director l…
DEA Inspections of Long-Term Care Facility Pharmacies
DEA inspections of long-term care facility pharmacies focus on automated dispensing registration, Schedule II fax prescriptions, a…
Florida Board of Medicine Probable Cause Panels and Administrative Complaints
How a Florida DOH complaint reaches a Board of Medicine probable cause panel, what an administrative complaint is, and the electio…