Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
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Who Files Qui Tam Suits Against Healthcare Providers
Qui tam suits against healthcare providers come from billers, compliance officers, departing staff, competitors, and data-mining f…
Whistleblower Suits Against Telehealth Companies
A telehealth company typically first learns of a qui tam case against it from a civil investigative demand, months before any comp…
Texas Medical Board Complaints: Process and Response
A Texas Medical Board complaint moves through jurisdictional screening, investigation, an informal conference, and a contested cas…
Surgical Dressing Claims: Supplier Records Under DME MAC Review
Home dressings bill to the DME MAC on a track separate from the clinic's procedure claims, and that track draws its own contractor…
State Attorney General Investigations of Telehealth Companies
State attorneys general use consumer protection law, not payer rules, to probe telehealth advertising, billing, clinician oversigh…
Med Spa Medical Directors and Board Complaints
A board complaint against a med spa medical director turns on supervision and ownership, not whether the physician treated a patie…
The Stark Law: What the Physician Self-Referral Ban Prohibits
What the Stark Law's physician self-referral ban prohibits: the referral, the financial relationship, and the bar on the Medicare…
Selective vs Non-Selective Debridement: CPT 97597, 97598 and 97602
Selective debridement (97597, 97598) and non-selective debridement (97602) are coded and reviewed differently, not interchangeable…
FDA's Bulk Drug Substance Categories 1, 2 and 3 for Compounders
FDA sorts nominated bulk drug substances into three interim categories, each carrying a different compounding posture and legal ex…