Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
More articles — Page 53
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Wound Care in Skilled Nursing Facilities: Audit Exposure
SNF consolidated billing bundles most wound care into the Part A rate. Facility, practitioner, and Part B billing splits are drawi…
Venous Leg Ulcer Care and Compression-Therapy Documentation
Medicare pays for compression bandages only over a qualifying wound. The same chart entry backs the pump, the graft, and every cla…
Audio-Only Telehealth: What Is Actually Billable
Medicare extended audio-only telehealth coverage through 2027, but the general and mental health rules diverge, and documentation…
Asynchronous Telehealth and Store-and-Forward Billing
Medicare pays for store-and-forward telehealth only through Alaska and Hawaii demonstration sites. Outside that lane, billing expo…
Document Preservation When a UPIC Audit Opens
A UPIC audit notice starts the preservation clock on EHR audit trails, signature logs, and adjudication records well before any la…
Medical Directorship Agreements Under Kickback Scrutiny
A medical directorship survives Anti-Kickback Statute scrutiny only when compensation reflects fair market value for services actu…
Living Under a Corporate Integrity Agreement
A Corporate Integrity Agreement's real work starts at settlement: IRO reviews, a 30-day Reportable Event clock, and stipulated pen…
Reverse False Claims Liability for Retaining an Overpayment
Retaining a known Medicare or Medicaid overpayment past the 60-day deadline can itself be a False Claims Act violation under the r…
Appealing a UPIC Overpayment Determination
UPIC overpayment determinations trigger Medicare's five-level appeal process, with strict 30- and 60-day windows controlling wheth…