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 Care LCD Compliance Across MAC Jurisdictions
CMS nationalized the skin substitute payment rate for 2026, but coverage still depends on which Medicare Administrative Contractor…
Stark Law Violations Feeding False Claims Liability
A Stark Law self-referral violation needs no intent, and billing Medicare for the referred service can turn it into False Claims A…
Parallel Civil and Criminal Healthcare Proceedings
When civil discovery runs alongside a criminal healthcare fraud investigation, sequencing, Fifth Amendment exposure, and stay moti…
Board Interviews: Should You Attend Without Counsel
A medical board's informal interview is a recorded, formal investigative step, and how a physician handles it can decide the case.
Self-Disclosure Versus Waiting for the Qui Tam
OIG's Self-Disclosure Protocol and DOJ's FCA cooperation credit both reward disclosing first, before a qui tam relator files under…
Behavioral Telehealth Audits
Medicare extended behavioral telehealth coverage through 2027, but UPIC and MAC reviewers are auditing session time, modality, and…
Wound Care Kickback Exposure: Manufacturer Relationships
Rebates, consulting fees, and free skin substitute product tied to referral volume can trigger Anti-Kickback Statute and False Cla…
Money Laundering Counts in Healthcare Fraud Indictments
Money laundering counts under 18 U.S.C. 1956 and 1957 can add 20 years of exposure and open forfeiture reaching beyond fraud proce…
UPIC Audit Defense Timeline: Notice to Resolution
Each stage of a UPIC audit, the 30-day records request, the review period, and the five-level Medicare appeal, with realistic dura…