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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State Telehealth Modality Requirements
States disagree on whether audio-only visits satisfy telehealth exam rules, creating licensure and false claims exposure for multi…
Worthless Services Claims Under the FCA
Worthless services claims treat reimbursement as false because the care itself had no value, not because it was miscoded or unneed…
Wound Care Practice Acquisitions and Audit Liability
A wound care acquisition can inherit the seller's audit exposure. What diligence should uncover, and how the 60-day overpayment cl…
Telemarketing-Driven Healthcare Fraud Schemes
How telemarketing and telehealth lead-generation schemes work, the DOJ takedowns built on them, and how a legitimate physician's e…
When a Wound Care Audit Becomes an FCA Case
The civil investigative demand, payment suspension, and extrapolated demand signals that mark when a wound care Medicare audit bec…
Under Seal: What Happens Before You Know You Are Sued
A qui tam seal can run for years while the government investigates. Here is what 31 U.S.C. Section 3730(b) requires and how provid…
Self-Auditing Wound Care Claims Before the Payer Does
How to sample your own wound care charts, quantify extrapolated exposure, and decide between the 60-day refund rule and OIG self-d…
Signing Orders From a Telehealth Platform: Your Exposure
Chart review adequacy, patient contact, and the DME and lab order pipeline determine whether a signed telehealth order becomes a f…
RPM Device Supply and Kickback Questions
Free or below-cost RPM devices from vendors can trigger Anti-Kickback Statute and beneficiary inducement exposure for telehealth p…