Diana Yastrovskaya
Articles by Diana
Understanding UPIC Audits: A Guide for Healthcare Providers, Pharmacies, and Medical Practices
UPIC audits are serious government probes into suspected Medicare and Medicaid billing errors that can quickly turn from a simple…
PBM Member Denial Audit Findings: A Growing Threat to Pharmacies
Pharmacies undergoing a Pharmacy Benefit Manager (PBM) audit are typically prepared to address inventory discrepancies and documen…
From Minor PBM Audit Finding to Major Liability: How Small Issues Trigger Big Consequences
Pharmacies often approach a PBM audit with the understanding that small discrepancies and modest recoupments are simply part of do…
HLA Wins Full Reversal of PBM Credentialing Denial for an Independent Pharmacy
This week, Health Law Alliance achieved full reversal of a PBM credentialing denial for a New York pharmacy, mere weeks after it r…
Why Even Minor Documentation Errors Can Be Costly for Pharmacies Facing a PBM Audit
PBMs are using rigid documentation standards to recoup payments and pressure pharmacies. Minor clerical errors can now threaten re…
The Hidden PBM Threat Putting Pharmacies at Risk: Affiliation-Based Network Terminations
PBMs are quietly expanding their power, terminating pharmacies based on affiliation rather than wrongdoing and putting entire busi…
Health Law Alliance Successfully Defends a New York Pharmacy in an Optum Audit
Facing an Optum PBM audit that threatened network participation, a New York pharmacy turned to Health Law Alliance for strategic l…
PBM Enforcement Trends Independent Pharmacies Must Prepare for in 2026
Independent pharmacies are heading into 2026 under tighter PBM oversight, more aggressive audit practices, and evolving reimbursem…
PBM Audit Triggers: Understanding How Prescription Activity Is Evaluated
Pharmacy benefit managers (PBMs) increasingly use data analytics and algorithmic surveillance to identify “red flag” prescriptions…
Health Law Alliance Successfully Reverses OptumRx’s Network Termination for a Michigan Pharmacy
We are proud to announce that the Health Law Alliance has successfully reversed a network termination from OptumRx for a Michigan-…
When Inventory Discrepancies Become Audit Nightmares: Understanding One of the Most Common and Costly Audit Findings
Inventory reconciliation is one of the most scrutinized areas in PBM and payer audits and even small discrepancies can trigger maj…
Collateral Consequences of PBM Audits: What Pharmacies Need to Know
PBM audits can quickly escalate from routine reviews into high-stakes enforcement actions with lasting financial, reputational, an…
Victory for an Independent Pharmacy: Health Law Alliance Successfully Reverses Over $30,000 in PBM Inventory Discrepancy Findings
Health Law Alliance successfully overturned more than $30,000 in alleged inventory discrepancy findings asserted by Express Script…
Navigating PBM Audits: A Legal Guide for New Pharmacy Owners
New pharmacy owners face complex PBM audit requirements that demand strict documentation, accurate claims, and ongoing compliance.…
How Pharmacies Can Challenge Unfair PBM Audit Findings
PBM audits can leave pharmacies facing exaggerated findings, steep recoupments, and even network termination. With the right strat…
Top Red Flags That May Trigger a PBM Audit
PBM audits can be disruptive, costly, and often triggered by high prescription volumes, dispensing irregularities, or claim activi…
DME Supplier Defense Attorneys' Guide to the Different Types of Government Audits
For DME suppliers, a notice from CMS can be daunting, especially when you're trying to figure out the difference between a TPE, SM…
More Than a Records Request: The Threat of UPIC Audits for DME Suppliers
For DME suppliers, a letter from a Unified Program Integrity Contractor (UPIC) is not a routine records request; it's a high-stake…
Building an Audit-Proof Documentation System for Your DME Supplier Business
In a CMS audit, your documentation is your only defense. A missing signature or an incomplete progress note can lead to a costly o…
By Appointment Only: How DME Suppliers Can Prevent Unexpected DME License Revocations
DME suppliers can prevent unexpected and costly license revocations by strategically applying with a "By Appointment Only" designa…
Resolving Prescription “Red Flags” Is No Longer Optional: Federal Scrutiny Tightens on Controlled-Substance Dispensing
Pharmacists must resolve “red flags” under the Controlled Substances Act’s corresponding-responsibility requirements before dispen…
Collateral Consequences Mount Quickly After Adverse DEA Inspection
Adverse findings during a DEA inspection can trigger a chain reaction of serious consequences for pharmacies, including increasing…
Heath Law Alliance Secures Reversal of a Medicaid Payment Suspension
Health Law Alliance successfully secured a full reversal of a Medi-Cal payment suspension for a California pharmacy, overturning s…
How DME Suppliers Can Maintain Compliance with Medicare Enrollment Requirements
If you are a Durable Medical Equipment (DME) supplier and you are fearful of being scrutinized by CMS or the National Provider Enr…
HLA Attorney Anthony Mahajan Secures Major Victory Over Cardinal as Federal Court Dismisses Lawsuit Against Independent Pharmacies
Health Law Alliance secured a major win for independent pharmacies with the dismissal of Cardinal Health’s lawsuit, exposing it as…
Health Law Alliance Earns Reinstatement for DME Supplier Whose Medicare Billing Privileges Were Unjustly Revoked
Due to Health Law Alliance’s advocacy, a prominent DME vendor in Texas had their billing privileges reinstated this week, without…
DEA Registration Requirements for Healthcare Providers: How to Stay Compliant
Understanding DEA registration requirements is crucial for healthcare providers handling controlled substances. Compliance with st…
Should You Voluntarily Surrender Your DEA Registration? What Healthcare Professionals Need to Know
Considering voluntarily surrendering your DEA registration? Our experts can help you navigate the process and understand your opti…
PBM Audit Alert: Express Scripts Targeting Pharmacies for "Claim Phishing"
Express Scripts is using aggressive audits and investigations to recoup the dollar value of test claims that were never paid. Don'…
A Step-by-Step Guide to Securing (and Keeping) Your DEA Registration
Learn how to obtain and protect your DEA registration with our step-by-step guide, updated for 2025 telehealth rules and audit tre…
How PBMs Profited from the Opioid Crisis: The Hidden Deals Fueling Addiction
Pharmacy Benefit Managers prioritized profits over safety, accepting rebates from opioid manufacturers and enabling unrestricted a…
DEA Inspections Overview: What to Expect and How to Prepare for a DEA Inspection
Learn what to expect during DEA inspections and how to protect your practice with proactive preparation strategies.
Pennsylvania Board Closes Investigation of HLA Client with No Action
Telemedicine business models may prompt regulatory scrutiny, including board investigations. In this case, HLA's experienced defen…
Triumph Over Optum: HLA’s Tenacious Advocacy Reverses Optum’s Termination of a Texas Pharmacy
Health Law Alliance successfully reversed Optum’s termination of a Texas pharmacy from its network, protecting the pharmacy from s…
U.S. Justice Department Investigates Alleged Medicare Fraud Involving COVID-19 Test Kits
The U.S. Justice Department is investigating allegations of Medicare fraud, where senior citizens' ID numbers were used to order u…
HLA Convinces Optum to Reverse PBM Audit Termination
Health Law Alliance is pleased to announce that Optum recently agreed to reverse its network termination of a Texas pharmacy clien…
Victories Against Optum Rx: Protecting Pharmacy Clients Nationwide
Health Law Alliance has successfully challenged Optum Rx's termination decisions for numerous pharmacies, ensuring they can contin…
OTC Enforcement Update and PBM Audit Alert
On the heels of federal criminal investigations into OTC card usage, payors are now auditing OTC processes and imposing severe san…
Safeguarding Independents: HLA Reverses PBM Termination on Appeal
PBMs are huge companies that often use their market power in an abusive and predatory manner. This case study and successful netwo…
National Audit Services are No Replacement for Attorney Advice
National audit assistance services cannot provide the legal expertise, subject matter knowledge, or audit leverage that healthcare…
Federal Prosecutors Decline Criminal Prosecution of HLA Client
Following a PBM audit that uncovered a $6.5 million billing discrepancy, federal prosecutors opened an investigation. After HLA wa…
State Board Declines Case Against HLA Client
PBM audits may result in collateral consequences, including licensing and disciplinary proceedings. In this case, HLA's experience…
Introduction to Medicare Audits
The federal government (HHS-OIG) is prioritizing audits of pharmacy claims in 2024. This signals that increased enforcement action…
HLA Wins Network Reinstatement for Illinois Pharmacy
PBMs are increasingly terminating pharmacies for minor infractions of the provider manuals or network enrollment forms. These term…