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 22
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Sterility Testing Under USP 797: When It Is Required
USP 797 ties sterility testing to a CSP's category, its beyond-use date, batch size and starting components, not to every preparat…
Wound Care Management Companies: MSO Structure and Fee Risk
How the clinician-owned practice and management company split in wound care draws corporate practice and anti-kickback scrutiny.
Segregated Compounding Areas Under USP 797: What Inspectors Cite
USP 797 limits segregated compounding areas to Category 1 preparations. Here is what inspectors cite on placement, certification,…
Recoupment in Medical Billing: What It Means and How Medicare Collects
Medicare recoupment withholds an overpayment from future payments, not just the audited claims. Here is how it works and how it di…
Services Not Rendered Allegations: How They Are Built and Answered
How investigators detect billing for services never performed, the documentation gaps that mimic it, and how providers build the d…
Pill Mill Prosecutions: The Case Against Prescribers and Pharmacies
Pill mill is a label, not a crime. The federal theory, the Ruan standard, and the charges prosecutors add once a pattern is proven…
Accused of Drug Diversion at Work: Nurses and Anesthesia Providers
A nurse or anesthesia provider named in a facility diversion investigation faces a licensing board case, a DEA report, and sometim…
Lack of State Authority: How a License Action Ends a DEA Registration
A DEA registration depends on state authority to handle controlled substances. A state license action can end it without DEA reach…
DME Supplier Compliance Programs: Referrals, Marketing and Screening
OIG's DME compliance guidance covers referral and marketing arrangements, exclusion screening, refill rules, and accreditation, no…