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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The Medicare Audit Process: Contractors, Stages, and Deadlines
MAC, RAC, UPIC, SMRC, CERT: which Medicare contractor is auditing you determines the risk. The stages and deadlines every provider…
What a PBM Audit Really Costs: Extrapolation and Recoupment Explained
The claims named in a PBM audit notice are rarely the real exposure. How sampling and extrapolation turn a small finding into a de…
GLP-1 PBM Audits in 2026: The Enforcement Playbook
GLP-1 claims are the leading PBM audit target of 2026. What OptumRx, Caremark, and Express Scripts flag, and how pharmacies defend…
How to Respond to a PBM Audit Letter
A PBM audit letter starts a recoupment clock. What a pharmacy does in the first days shapes the demand, the appeal, and whether on…
Feds Seize $2 Million From Pasadena Wound Care Clinic Amid Data-Driven Medicare Fraud Allegations
In a stark reminder of the federal government’s enhanced capability to rapidly freeze the assets of its enforcement targets, the U…
Understanding UPIC Audits: A Guide for Healthcare Providers, Pharmacies, and Medical Practices
UPIC audits are serious government probes into suspected Medicare and Medicaid billing errors that can quickly turn from a simple…
CMS Imposes Nationwide Moratorium on Hospice and Home Health Enrollments: A Major Escalation in the J.D. Vance Task Force Crackdown
The Centers for Medicare & Medicaid Services (CMS) has imposed a six-month nationwide moratorium on new hospice and home health pr…
New Executive Order Signals Faster Psychedelic Drug Approvals--and Closer DEA Scrutiny
On Saturday, April 18, President Trump signed an executive order designed to accelerate federal drug approvals for psychedelic dru…
Texas Moves to Rein in Ketamine Therapy: And Other States are Likely Next
The regulatory environment surrounding ketamine therapy is entering a new phase of maturity and enforcement. Recently, the Texas M…