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 21
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Caremark Audit Discrepancy Codes Explained
Caremark's Provider Manual sorts every audit discrepancy code onto one of two tracks: resolvable with a specific document, or alre…
Home Health Review Choice Demonstration: Choosing Your Option
CMS's Review Choice Demonstration runs pre or postpayment review on home health claims in six states, with a 90% target to earn re…
Home Health Homebound Status: Proving It Under Review
The two-part CMS test for homebound status, the absences that do not break it, and the documentation that actually survives a Medi…
DEA Telemedicine Special Registration: Where the Rule Stands
The DEA's telemedicine special registration is still proposed, not final. The controlled-substance prescribing flexibilities run t…
Controlled Substances in Nursing Homes: Disposal and Diversion
DEA's long-term care disposal rule sets a three-business-day clock and a two-employee handling rule. A missing dose opens a divers…
Compounded GLP-1 Marketing After the Shortage Ended
FDA warning letters to telehealth sellers and a compounding pharmacy show what GLP-1 marketing claims and compounding are still la…
BPC-157 and Compounding: The Regulatory Position
BPC-157 left FDA's Category 2 safety-risk list after its nominations were withdrawn, but it still is not on the approved 503A bulk…
The Medicare Program Integrity Manual: Chapters That Govern an Audit
CMS writes this manual for its Medicare contractors, distinct from a statute. The chapters a provider under audit needs, and how t…
The False Claims Act: What the Government Must Prove Against a Provider
The five elements the government or a relator must prove under the False Claims Act, and where a provider's defense lives in each…