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 64
Page 64 of 114 · 1029 articles
Inventory Reconciliation Shortfalls in Pharmacy Audits
PBMs flag inventory shortfalls by matching purchase invoices to billed claims. Legitimate variance and shortage-driven NDC swaps e…
Provider-Based Billing and Medicare Audit Exposure
Provider-based status under 42 CFR 413.65 controls whether a hospital facility fee survives audit, and a 2026 federal mandate rais…
UPIC Audits of Clinical Laboratories
UPIC audits of clinical laboratories target genetic test billing, standing orders, and toxicology panels lacking individualized me…
Aggravated Identity Theft in Healthcare Prosecutions
How 18 U.S.C. § 1028A adds a mandatory, consecutive two-year term to a healthcare fraud sentence, and which billing conduct trigge…
Anti-Kickback Violations as FCA Predicates
The 2010 ACA amendment made AKS violations automatic false claims, and the tainted claim theory multiplies FCA damages across ever…
Ability to Pay in FCA Settlement Negotiations
DOJ requires a certified financial disclosure before crediting an ability-to-pay claim in an FCA settlement, and a flawed filing c…
Insulin and Diabetic Supply Audit Findings
PBM audits target high-utilization insulin, test strip, lancet, and CGM claims. Here is the quantity-limit and days-supply documen…
A Search Warrant at Your Practice: The First Hour
Scope review, staff instructions, privilege assertion, and preserving the seizure record: what to do in the first hour of a federa…
UPIC Audits of Ambulance Suppliers
Repetitive non-emergent transport claims draw UPIC scrutiny over run sheet documentation, physician certification statements, and…