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 17
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UPIC Audits of Wound Care in Nursing Facilities
A $45M DOJ settlement with a bedside wound care provider shows how UPIC audits reach nursing facility records, not just the billin…
RPM Vendor Arrangements With Nursing Homes and the Anti-Kickback Statute
Free devices, per-resident fees, and revenue shares RPM vendors offer nursing homes can be Anti-Kickback Statute remuneration with…
SNF Consolidated Billing: Which Services Belong on the Facility Claim
Medicare's SNF consolidated billing rule bundles nearly every service into the facility's claim, and outside suppliers that bill P…
Skilled Nursing Facility Medical Review: The Skilled Need Question
Medicare's skilled-need test, not patient improvement, decides whether a Part A stay survives medical review under the Jimmo maint…
Skin Substitutes in Nursing Home Residents: Audit Exposure
Skin substitute claims for nursing home residents can violate Medicare's SNF consolidated billing rule before medical necessity is…
Skin Substitute LCDs: Where the Coverage Rules Stand
CMS withdrew the 2026 skin substitute LCDs in December 2025, but the $127.14 per sq cm payment rule and the new audit exposure it…
Nursing Home Administrator License Investigations
A facility survey deficiency and a state board license complaint are separate proceedings, but one record can open both against an…
False Claims Act Exposure in Remote Patient Monitoring
Remote patient monitoring billing exposure turns on the civil False Claims Act's knowing and materiality standards, not on an ordi…
UPIC Audits of Skilled Nursing Facilities
UPICs review SNF consolidated billing and PDPM coding, and a small sample of flagged claims can be extrapolated into a demand many…