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 14
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Building a PBM Audit Response Binder, Claim by Claim
A claim-by-claim binder, indexed to the PBM's own numbers, turns a chaotic audit response into evidence that holds up on appeal.
Multiple Schedule II Prescriptions and the Rule on Issuing Several at Once
DEA rule 21 CFR 1306.12 lets a prescriber issue multiple Schedule II prescriptions at one visit. Here is what pharmacists must ver…
Judicial Review of a DEA Final Order in the Court of Appeals
What happens after a DEA Administrator's final order: the deadline to petition the Court of Appeals, the stay process, and the sta…
Compounded Pain Creams and Federal Fraud Prosecutions
DOJ has pursued civil settlements and criminal convictions over compounded pain and scar cream billing to TRICARE and Medicare Par…
Compounded GLP-1 Dosing Errors and Syringe Instructions
FDA has linked compounded semaglutide overdoses to mg-to-unit syringe confusion. The labeling and counseling records that protect…
Telehealth Flexibilities in 2026: What Expired and What Remains
Medicare telehealth flexibilities run through December 31, 2027, but one RHC/FQHC billing code expired, and DEA's prescribing dead…
DME Prior Authorization: The Required List and How It Works
CMS requires prior authorization before paying certain DME claims. Here is the current required list, provisional affirmation, and…
SNF Three-Day Qualifying Stay Errors and Denials
A two-day inpatient hospital stay does not qualify for Medicare SNF coverage. Here is how the three-day count, current waivers, an…
L3 Denials and Medicare Payment Suspensions
Seeing L3 "denials" on a Medicare remittance? The L3 code can signal a payment suspension. What it means, how suspensions work, an…