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ESI 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 ESI 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.
Common Questions About Express Scripts (ESI) Audits
Do Express Scripts audits target specific pharmacy types?
PBMs like ESI often unfairly focus on independent, specialty, and compounding pharmacies versus large chains. But all pharmacy types must contend with aggressive Express Scripts audits. Having legal advocates levels the playing field.
Will filing Express Scripts appeals or settlements impact my network contracts?
Retaliation for exercising ESI audit appeal rights is prohibited. We incorporate proper legal protections into Express Scripts audit responses and settlements. Maintaining existing contracts is always a priority.
Can your guidance help prevent future unfair targeting by Express Scripts?
Absolutely. We provide tailored compliance recommendations so pharmacies can reinforce areas prone to ESI audit scrutiny. Proper documentation is critical to rebutting Express Scripts audit allegations.
What recourse exists if advance notice isn't provided?
Lack of proper ESI audit notice may violate the law in many states. We leverage penalties around insufficient notice periods into negotiation leverage for your pharmacy.
Can you help if my license or network participation is jeopardized by an Express Scripts audit?
Yes. We ensure that ESI audit sanctions comply with applicable federal and state laws. PBMs like Express Scripts are prohibited from acting in bad faith or arbitrarily under both applicable law and the parties’ agreements.
What are the costs of legal representation for Express Scripts audits?
We offer flexible fee arrangements based on the scope of representation required and ESI audit stage. The earlier we are involved the better, as we can shape and limit Express Scripts audit scope, making legal representation more effective and less costly.
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