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 19
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New York Investigates More Than 100 Social Adult Day Care Providers
New York ordered prepayment review, payment suspensions, and a continued moratorium for social adult day care providers after a jo…
Remote Patient Monitoring in Nursing Facilities
RPM helps nursing facilities monitor CHF, COPD, and diabetes, but device choice, EHR integration, and Part A billing rules decide…
Hospice Fraud Prosecutions: How Criminal Cases Are Built
DOJ turns hospice fraud into a criminal case with grand jury subpoenas, kickback counts and false certifications, apart from civil…
Healthcare Fraud Investigations of Nursing Home Operators
DOJ's individual accountability policy means a nursing home fraud investigation often reaches the owner personally, not only the f…
False Claims Act Cases Against Skilled Nursing Facilities
Recent DOJ settlements show three recurring False Claims Act theories against skilled nursing facilities: therapy upcoding, worthl…
False Claims Act Cases Against Hospices
The Eleventh Circuit's AseraCare decision limits hospice False Claims Act cases to proof of objective falsehood, not a second doct…
State PBM Reform Laws in 2026: What Changed for Pharmacy Audits
Oklahoma and Delaware enacted 2025 and 2026 laws that bar PBM audit extrapolation, cap how often pharmacies can be audited, and sh…
OptumRx Audit Appeals: What to Submit and When
A preliminary OptumRx finding is only the start. State law sets real deadlines for what a pharmacy must submit, and when, before t…
Research Use Only Peptides Sold to Clinics: The Legal Risk
Clinics that inject patients with research use only peptides carry the same FDCA exposure as the supplier, and FDA's letters say t…