PBM Audits & Defense
Network audits, recoupments, terminations, and appeals against Caremark, OptumRx, Express Scripts, and other PBMs.
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…
Standing Up for Pharmacies: How HLA Fought and Reversed Optum’s Termination of a New York Pharmacy
In a recent victory, our attorneys at Health Law Alliance achieved a full reversal of Optum’s termination of a New York pharmacy.…
HLA's Diana Yastrovskaya Featured on Live TV for PBM Expertise
The feature underscores HLA’s mission to elevate thought leadership within the healthcare space and provide trusted expertise on i…
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…
HLA Wins Full Reversal of PBM Audit Findings for Maryland Pharmacy
Health Law Alliance achieved full reversal of final audit findings for a Maryland pharmacy, just one of numerous victories our att…
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'…
PBM Audits: Proven Strategies, Practical Insights, and Expert Guidance
PBM audits extend beyond paperwork, assessing pharmacy operations, staff preparedness, SOPs, and compliance culture. Proactive str…