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 58
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Negative Pressure Wound Therapy Billing Under Audit
How NPWT device documentation, duration-of-use limits, and DME overlap with professional wound care billing become audit findings.
Free EHR and Technology Donations: Kickback Limits
The Stark Law and Anti-Kickback Statute let hospitals donate EHR technology to referring physicians, but only inside strict, easil…
FCA Retaliation Claims Under Section 3730(h)
How Section 3730(h) protects employees who report suspected fraud, and what employers must prove to defend the retaliation count o…
UPIC Data Mining: How You Got Selected
How CMS's predictive analytics and peer-comparison scoring select physicians for a UPIC audit, and what a high-risk billing profil…
Responding to a PBM Audit While Short-Staffed
How to triage a PBM audit response when your pharmacy is short-staffed, what a technician can handle, and what needs the pharmacis…
UPIC Beneficiary Interviews and What They Ask
When a UPIC contacts a physician's Medicare patients directly, what investigators ask and how those answers become part of the cas…
FBI Agents at the Door: What Employees Should Know
FBI and HHS-OIG interviews of practice employees are voluntary. What staff should know in advance about false-statement exposure u…
Preserving Your Appeal Rights in a PBM Audit
Waiver traps hide in the correspondence that comes before the formal appeal. What preserves a pharmacy's PBM audit appeal rights,…
Hyperbaric Oxygen Therapy Audits
CMS covers hyperbaric oxygen therapy for only fifteen conditions, and OIG audits found the majority of sampled claims failed to do…