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 34
Page 34 of 113 · 1018 articles
UPIC Medical Review: Nurse Reviewers and Contractor Medical Directors
How a UPIC medical necessity denial moves from coding staff to a nurse reviewer to a contractor medical director, and what a rebut…
Medicare Waiver of Recovery and Limitation on Liability
Waiver of recovery and limitation on liability can each eliminate a Medicare overpayment demand, but they turn on different proof…
Asking DOJ to Dismiss a Qui Tam Under Section 3730(c)(2)(A)
Section 3730(c)(2)(A) lets DOJ dismiss a relator's qui tam suit over objection. What the post-Polansky standard requires and how a…
Appealing a Board Disciplinary Order in Court
Once a state medical or pharmacy board's disciplinary order is final, judicial review is generally limited to the existing record,…
When Federal Agents Seize Your Practice Bank Accounts
What a seizure warrant on a practice's operating account means before any charge is filed, and the argument for releasing funds no…
Your PSAO's Role in a PBM Audit
A PSAO holds the network contract behind a PBM audit and often handles the notice and remittance, but the response deadline and pr…
UPIC Audit Results Letters: Reading the Findings and Responding
A UPIC review results letter states claim-by-claim findings, the error rate, and any extrapolated overpayment before the file reac…
Reversing and Rebilling Claims After a PBM Audit Notice
Reversing and rebilling a flagged claim after a PBM audit notice can read as concealment, not correction, under how provider manua…
State Pharmacy Audit Laws and When They Apply to a PBM Audit
Most states protect pharmacies during PBM audits through their own audit statutes, but a self-funded plan's ERISA status can chang…