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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UPIC Audits of Partial Hospitalization and Intensive Outpatient Programs
UPIC reviews of PHP and IOP claims turn on physician certification timing, program hours, and individualized progress notes.
Texas Pharmacy Audit Law: Rights When a PBM Audits You
Texas Insurance Code Chapter 1369 sets PBM audit notice, sampling, and anti-extrapolation rules, with limits set by ERISA and Medi…
Florida Pharmacy Audit Law and PBM Audits
Florida regulates PBM pharmacy audits through two statutes enforced by the Office of Insurance Regulation, with limits set by ERIS…
Medicare Advantage Plan Special Investigations Units and Provider Audits
A Medicare Advantage plan's own Special Investigations Unit, not a federal contractor, opens provider audits under Part C.
Medicare Advantage Chart Review Programs and Add-Only Diagnoses
How Medicare Advantage plans add diagnoses through retrospective chart review, and why add-only practices draw False Claims Act sc…
USP 797 Immediate-Use Compounding: Where the Exception Ends
USP 797's immediate-use exception has strict conditions on timing, product limits, and labeling that batch production often violat…
USP 797 Category 1, 2 and 3 CSPs Explained
USP 797 sorts every compounded sterile preparation into Category 1, 2 or 3, and the category sets its environment, testing and bey…
FDA Greenlights 503A Compounding for Certain Peptides
FDA's new enforcement discretion policy temporarily lets 503A pharmacies compound six peptides, including BPC-157 and TB-500. What…
False Claims Act Exposure for DME Suppliers
Missing orders, absent delivery proof, thin necessity records and kickback-tainted referrals each create civil False Claims Act ex…