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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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…
State False Claims Acts and Parallel Recoveries
State False Claims Acts let attorneys general pursue Medicaid fraud independent of DOJ, creating exposure a federal settlement alo…
Consent Orders: Reading the Long-Term Consequences
A signed consent order triggers a permanent NPDB report, payer credentialing disclosures, and possible OIG exclusion long after th…
Building a Wound Care Compliance Program
Chart auditing cadence, coding review, and remediation records are what turn a self-identified billing error into a correction ins…
UPIC Audits and Your Medicare Enrollment Status
UPIC audit findings can trigger Medicare payment suspension, deactivation, or revocation, with a reenrollment bar that runs for ye…
UPIC Audits of Pharmacies Under Part D
UPICs review Part B and Medicaid pharmacy claims, not Part D. Here is how the two audit tracks overlap through prescriber pattern…
PPP Loan Fraud Enforcement Against Healthcare Practices
Certification exposure on 2020 PPP loans stays live through 2030. Recent DOJ judgments against healthcare businesses turn on a sig…
Patient Recruiting and Marketing Arrangements
Percentage-based marketing fees and patient recruiting arrangements can trigger Anti-Kickback Statute and False Claims Act exposur…