Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
More articles — Page 12
Page 12 of 112 · 1007 articles
EHR Audit Logs in Criminal Healthcare Investigations
An EHR's audit trail records who touched a chart, when, and what they did, the same system data investigators and defense counsel…
Pharmacist-Prescribed Claims in PBM Audits: Naloxone, Test-and-Treat and Contraception
Naloxone, test-and-treat and contraception claims bill under a pharmacist's own prescribing authority, and PBM audits are flagging…
MFCU Search Warrants and Records Seizures
When MFCU investigators execute a search warrant at a healthcare practice, Fourth Amendment limits, privilege protections, and cou…
Compromise and Settlement of a UPIC Overpayment
CMS can compromise a Medicare overpayment of $100,000 or less, but any indication of fraud removes that option and sends the claim…
Complaints and Tips That Start a UPIC Investigation
Complaints, tips and referrals from beneficiaries, employees, competitors and the OIG Hotline can open a UPIC investigation as fas…
Medicaid Substance Use Disorder Treatment Provider Audits
Medicaid audits of outpatient, IOP, residential and OTP providers turn on ASAM level-of-care proof, drug-testing patterns and grou…
Medicaid Psychotherapy Time Coding and Audit Findings
Medicaid reviewers downcode or deny psychotherapy claims that lack face-to-face time documentation, and the exposure can extrapola…
Express Scripts Desk Audit Packet Checklist
A claim-by-claim checklist for organizing prescription images, signature logs, invoices, and prescriber notes for an Express Scrip…
Expired Prescriptions and Refills Beyond Authorization in PBM Audits
A PBM audit tests prescription validity and refill counts; the federal controlled-substance limit and the state general limit are…