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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Structuring an FCA Settlement
How damages allocation, release scope, CIA terms, and payment structure interact once a False Claims Act matter reaches the settle…
Criminal Charges and Your Professional License
Self-reporting duties to state boards, interim suspension standards, and how a license case runs beside a pending criminal charge,…
UPIC Education Letters: A Warning Worth Heeding
A UPIC education letter is the audit's most lenient outcome, not a clearance, and it signals remediation physicians should not ski…
Successor Liability for False Claims in an Acquisition
Whether an acquirer inherits a target's False Claims Act exposure turns on deal structure, diligence, and the exceptions to succes…
UPIC Audits of Telehealth Providers
UPICs mine telehealth claims for volume outliers, then test platform prescribing and encounter documentation against Medicare's te…
Continuing Education and Licensure Audit Findings
State boards audit CE compliance by random sample. A documentation gap can mean a fine, a cure period, or formal board discipline.
Statistical Sampling as Proof of FCA Liability
Courts increasingly let a sample of claims prove False Claims Act liability, not only damages. Here is how the methodology gets ch…
Wound Measurement Documentation That Survives Audit
Medicare's LCDs require three separate wound measurements and a documented reassessment when healing stalls. Most audit-failing ch…
Building a Telehealth Compliance Program
Licensure tracking across states, encounter-specific documentation standards, and self-auditing your telehealth claims before a pa…