Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
RAC Audits Versus UPIC Audits: Know Which One You Have
RAC audits chase improper payments for a contingency fee. UPIC audits investigate fraud and can trigger a payment suspension before any appeal.
All articles
Page 1 of 40 · 363 articles
New York OMIG Audits: Process and Defense
New York's OMIG moves audits through a draft report, a 30-day response window, and a 60-day appeal deadline that cannot be extende…
Hormone Pellet Therapy and Compounding Enforcement
Compounded hormone pellets raise two enforcement risks at once: the 503A office-use prescription gap and FTC marketing claim expos…
Interstate Shipping Limits and the 5 Percent MOU
The FDA's 503A interstate distribution MOU is suspended, not signed by any state. Here is what the 5 percent cap requires until ru…
QIC Reconsideration: Building the Record for ALJ
Level 2 of the Medicare appeals process sets a 180-day filing deadline and an evidence rule that can decide the case before it rea…
Employee Screening Obligations for DEA Registrants
DEA rules bar hiring anyone with a controlled-substance felony or a denied, revoked, or surrendered registration. What the duty to…
Magellan Rx Pharmacy Audit Defense
Magellan Rx audits pharmacy claims for commercial and Medicaid managed care plans, creating dual exposure under PBM and state prog…
Michigan Medicaid Audits and Provider Defense
How MDHHS OIG audits Michigan Medicaid providers, when self-audit and disclosure options apply, and how the state's appeal process…
Physician Orders and Certifications Under Audit
What a valid Medicare physician order or certification must contain, the timing and signature rules, and the defects that trigger…
Medicaid Transportation Provider Audits
State Medicaid programs and MFCUs are auditing non-emergency medical transportation providers over trip logs, eligibility, and mil…