PBM Audits & Defense
Network audits, recoupments, terminations, and appeals against Caremark, OptumRx, Express Scripts, and other PBMs.
HLA Wins Dismissal of Criminal Charges After PBM Audit
Health Law Alliance has successfully challenged OptumRx's termination decisions for numerous pharmacies, ensuring they can continu…
Pharmacy Benefit Managers (PBMs) Face Possible FTC Lawsuit
The Federal Trade Commission (FTC) plans to sue the top Pharmacy Benefit Managers (PBMs) for anti-competitive practices, including…
FTC Issues Interim Report Condemning Anticompetitive PBM Practices
The top Pharmacy Benefit Managers (PBMs) are condemned by the FTC for manipulating the healthcare system to generate significant p…
Express Scripts FWA Investigative Alert: Crackdown on CoverMyMeds Provider Accounts
Express Scripts is targeting prior authorization Fraud, Waste & Abuse involving the use of CoverMyMeds provider accounts by pharma…
Medicare Advantage Cuts to Increase PBM Pressures
Insurers have bet big on Medicare Advantage, but the government is slowly cutting back. Faced with rising medical loss ratios and…
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…
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…