Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
Corrective Action Plans After a Medicaid Audit
What a state Medicaid agency expects in a corrective action plan after an audit finding, who signs it, the follow-up review, and the risk if errors recur.
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Change of Ownership in Medicaid: Disclosure and Successor Liability
Buying or selling a Medicaid-enrolled provider means updating ownership disclosures, checking the seller's open audits and overpay…
Cloned Documentation and Copy-Forward Findings in Medicare Audits
How Medicare reviewers identify cloned or copy-forward EHR notes, why the finding becomes a medical necessity denial, and how to c…
Copay Collection Findings in PBM Audits
PBM auditors test copay collection against payment records and patient contact. A documented hardship waiver survives; an undocume…
Telehealth Platform Contracts: Fee Structures Under Scrutiny
Per-consult flat fees carry far less Anti-Kickback Statute exposure than percentage-based telehealth platform pay. What the fee fo…
Brand Manufacturer Lawsuits Over Compounded GLP-1 Drugs
Brand-name GLP-1 manufacturers are suing compounders and telehealth sellers directly, using false advertising and trademark claims…
AdvanceMed UPIC Audits: What to Expect
AdvanceMed's Midwestern Jurisdiction UPIC work now runs under the name CoventBridge. What the rebrand means for a physician facing…
Telehealth Modifier Use and Payer Variation
Medicare, Medicare Advantage, Medicaid, and commercial payers each apply different modifier and place-of-service rules, and the wr…
When a PBM Audit Triggers a State Board Referral
Some PBM audit findings do not stay a reimbursement dispute. They get referred to the state board of pharmacy, putting the license…
Medicare Advantage Plan Audits Versus Traditional Medicare
Medicare Advantage plans audit under provider contracts and RADV rules, not Medicare regulations, which changes both the audit tri…