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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Texas Compounding Rules: Class A, C and Sterile Pharmacy Requirements
Texas organizes pharmacy compounding by license class. Here is what separates Class A and C from the sterile designations, and wha…
Sermorelin and Growth Hormone Secretagogue Compounding Status
Sermorelin remains eligible for compounding even as FDA's Category 2 list reaches related growth hormone secretagogues. What it me…
Wound Care Claims Under Targeted Probe and Educate Review
Wound care claims fail Targeted Probe and Educate review over debridement coding errors and skin substitute documentation gaps, no…
Medicare Advantage Plans Denying Wound Care and Skin Substitute Claims
Medicare Advantage plans apply their own coverage criteria to wound care and skin substitute claims, and those denials run on a se…
False Claims Act Exposure for Clinical Laboratories
Clinical laboratories face civil False Claims Act exposure from unnecessary testing, panel billing, and marketer kickbacks tied to…
False Claims Act Exposure for Behavioral Health Providers
Psychotherapy time codes, supervision billing, and group therapy notes each create civil False Claims Act exposure when the record…
Self-Disclosure and Voluntary Refunds While a UPIC Audit Is Open
What an open UPIC review does to the Medicare overpayment reporting clock, which channel fits, and the risk of an uncoordinated re…
Privilege and Confidentiality in a UPIC Production
What physician practices can withhold or log when producing records to a UPIC, and how privilege survives later disclosure.
Partial Hospitalization Program Fraud Prosecutions
Partial hospitalization and intensive outpatient fraud cases turn on eligibility, group therapy content, and attendance records, n…