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 9
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Employee Interviews During a UPIC Investigation
UPIC investigators routinely interview practice staff, and an informal answer can trigger federal exposure under 18 U.S.C. Section…
Risk Adjustment Fraud and the FCA
DOJ's 2026 Medicare Advantage settlements show how unsupported HCC codes and one-sided chart reviews become False Claims Act liabi…
Wound Care in Skilled Nursing Facilities: Audit Exposure
SNF consolidated billing bundles most wound care into the Part A rate. Facility, practitioner, and Part B billing splits are drawi…
Venous Leg Ulcer Care and Compression-Therapy Documentation
Medicare pays for compression bandages only over a qualifying wound. The same chart entry backs the pump, the graft, and every cla…
Audio-Only Telehealth: What Is Actually Billable
Medicare extended audio-only telehealth coverage through 2027, but the general and mental health rules diverge, and documentation…
Asynchronous Telehealth and Store-and-Forward Billing
Medicare pays for store-and-forward telehealth only through Alaska and Hawaii demonstration sites. Outside that lane, billing expo…
Document Preservation When a UPIC Audit Opens
A UPIC audit notice starts the preservation clock on EHR audit trails, signature logs, and adjudication records well before any la…
Medical Directorship Agreements Under Kickback Scrutiny
A medical directorship survives Anti-Kickback Statute scrutiny only when compensation reflects fair market value for services actu…
Living Under a Corporate Integrity Agreement
A Corporate Integrity Agreement's real work starts at settlement: IRO reviews, a 30-day Reportable Event clock, and stipulated pen…