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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Ownership Disclosure Requirements in Medicaid Enrollment
Medicaid providers must disclose 5 percent owners and managing employees, and nursing facilities must now name private equity and…
Hospice Medicare Audits and Eligibility Challenges
CMS and OIG are scrutinizing hospice terminal prognosis documentation, long lengths of stay, and the aggregate cap under 42 CFR 41…
Transferring Controlled Substance Prescriptions Between Pharmacies
Schedule II prescriptions generally cannot transfer between pharmacies. Schedule III-V transfers follow one-time rules under 21 CF…
MFCU Subpoenas: Responding Without Making It Worse
MFCU subpoenas carry civil and criminal exposure at once. How to negotiate scope, review for privilege, and avoid the mistakes tha…
The Demonstrably Difficult to Compound List
FDA has proposed three drug categories that could no longer be legally compounded under 503A or 503B. What the list covers, and ho…
Ohio Medicaid Audits: Process and Deadlines
How Ohio Medicaid audits proceed from an ODM or SURS notice through reconsideration, adjudication, and appeal, and what providers…
Pennsylvania Medicaid Audits and Provider Appeals
How DHS audits Pennsylvania Medicaid providers, the repayment timeline, and the 30-day deadline to appeal to the Bureau of Hearing…
PBM Onsite Audit: How to Prepare for the Auditor Visit
How pharmacies should stage documents, designate a point of contact, and control scope before and during a PBM onsite audit visit.
Reassignment of Medicare Benefits: Where Groups Get Exposed
Reassignment shifts Medicare billing rights to the group, and with it, audit and overpayment exposure the group may not see coming…