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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When Inventory Discrepancies Become Audit Nightmares: Understanding One of the Most Common and Costly Audit Findings
Inventory reconciliation is one of the most scrutinized areas in PBM and payer audits and even small discrepancies can trigger maj…
More Than a Records Request: The Threat of UPIC Audits for DME Suppliers
For DME suppliers, a letter from a Unified Program Integrity Contractor (UPIC) is not a routine records request; it's a high-stake…
Navigating PBM Audits: A Legal Guide for New Pharmacy Owners
New pharmacy owners face complex PBM audit requirements that demand strict documentation, accurate claims, and ongoing compliance.…
Approaching the Telehealth Policy Cliff: Medicare Telehealth Flexibilities to Expire Next Week
Without further congressional action, COVID-19 era telehealth flexibilities are set to expire on September 30, 2025. Read more to…
OIG Doubles Down on Increased Oversight for RPM in New Report
On August 28, 2025, the US Department of Health and Human Services’ Office of the Inspector General published a report outlining b…
Top Red Flags That May Trigger a PBM Audit
PBM audits can be disruptive, costly, and often triggered by high prescription volumes, dispensing irregularities, or claim activi…
How Pharmacies Can Challenge Unfair PBM Audit Findings
PBM audits can leave pharmacies facing exaggerated findings, steep recoupments, and even network termination. With the right strat…
Standing Up for Pharmacies: How HLA Fought and Reversed Optum’s Termination of a New York Pharmacy
In a recent victory, our attorneys at Health Law Alliance achieved a full reversal of Optum’s termination of a New York pharmacy.…
DME Supplier Defense Attorneys' Guide to the Different Types of Government Audits
For DME suppliers, a notice from CMS can be daunting, especially when you're trying to figure out the difference between a TPE, SM…