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 33
Page 33 of 53 · 474 articles
The Federal Healthcare Fraud Statute (18 USC 1347) Explained
A physician's guide to 18 USC 1347: the elements, intent standard, penalties on conviction, and the line separating it from civil…
Grand Jury Subpoenas in Healthcare Investigations
A guide to document and testimony subpoenas, grand jury secrecy, privilege, and production strategy for physicians facing a federa…
UPIC Site Visits: How to Prepare and What Inspectors Review
An unannounced UPIC site visit can arrive without warning. What inspectors review, how staff interviews work, and why counsel belo…
The Credible Allegation of Fraud Standard in Medicaid Enforcement
A thin, unverified referral can trigger a mandatory Medicaid payment suspension. Here is how states define a credible fraud allega…
UPIC Audits Explained: The Fraud-Focused Medicare Contractor
UPICs investigate suspected Medicare and Medicaid fraud, not payment accuracy. What a UPIC letter means and how its mandate differ…
Medicaid Exclusion and Termination: Collateral Consequences of an Audit
A state Medicaid termination for cause can trigger mandatory cross-state termination and federal OIG exclusion. What physicians sh…
When to Engage a Medicare Audit Attorney
The points in a Medicare audit where legal exposure escalates: extrapolated demands, prepayment review, fraud referrals, and revoc…
Humana Pharmacy Audits: What to Expect and How to Respond
A guide to Humana Pharmacy Solutions audit formats, the documentation requested, common discrepancy findings, and the appeal windo…
MedImpact Audit Findings: How Pharmacies Respond
How MedImpact conducts desk and onsite pharmacy audits, the documentation standards it applies, and how a pharmacy should respond…