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CVS Caremark is Auditing or Terminating You. Without the right legal defense, you may face significant penalties and network exclusion. At Health Law Alliance, our legal team has successfully defended hundreds of clients against PBM audits, Fraud, Waste & Abuse (FWA) investigations, and network terminations. We have prevailed against CVS Caremark and have proven strategies for the audit and appeal process. Contact Us now for help.
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Former Government Regulators on Your Side – Our team of healthcare defense specialists is spearheaded by former federal and state prosecutors who understand how the government and its contractors use data mining and proprietary algorithms to identify potential Fraud, Waste & Abuse (FWA) for audits and investigation. Because we understand how the government builds cases, we use their playbook to beat them.
Healthcare Specialty Attorneys and Consultants – Health Law Alliance specializes in healthcare law and is dedicated to defending providers and their licenses from overreach. Our founding partner previously served as a top executive for the biggest companies in healthcare, including McKesson, Relay Health, CoverMyMeds, United Health Group, Optum, and United Healthcare. We know the tricks insurance companies use to deny claims, and use that inside information against them.
Proven Track Record – Some clients turn to us when stakes are the highest, when their businesses are threatened, when their license is challenged, and when their options are limited. Our wins against the government and insurance companies can be reviewed HERE. Many more clients, however, turn to us at the first sign of potential trouble, when we can neutralize the problem before it grows. Either way, we have your back from beginning to end.
Your CVS Caremark Audit Questions—Answered
What documents and data should I gather?
Initially, we’ll need CVS Caremark audit determination letters, audit reports, and potential financial records, such as credit card receipts or remittances. As we formulate technical arguments, additional CVS Caremark documentation may be requested. We will provide specifics on supporting materials.
Do CVS Caremark audits target specific pharmacy types?
PBMs like CVS Caremark often unfairly focus on independent, specialty, and compounding pharmacies versus large chains. But all pharmacy types must contend with aggressive CVS Caremark audits. Having legal advocates levels the playing field.
Will filing CVS Caremark appeals impact my network contracts?
Retaliation for exercising CVS audit appeal rights is prohibited. We incorporate proper legal protections into audit responses and settlements. Maintaining existing CVS Caremark contracts is always a priority.
What recourse exists if advance notice isn't provided?
Lack of proper 30-day written CVS Caremark audit notice violates statute in many states. We leverage penalties around insufficient notice periods into negotiation leverage for your pharmacy.
Can CVS audits impact DIR or BER/GER assessments?
Potentially. Depending on the scope of the CVS Caremark audit and the claims involved, any clawbacks should be reconciled in DIR, or BER/GER performance metrics. Our specialists ensure that any downstream CVS Caremark audit consequences are handled properly in your favor.
What are the costs of legal representation for CVS Caremark audits?
We offer flexible fee arrangements based on the scope of representation required and CVS Caremark audit stage. The earlier we are involved the better, as we can shape and limit CVS Caremark audit scope, making legal representation more effective and less costly.
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