Fill out the form below or call us at (800) 345-4125.
Optum 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 Optum and have proven strategies for the audit and appeal process. Contact Us now for help.
As Seen On
.avif)
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 OptumRx Audit Questions—Answered
Do OptumRx audits target specific pharmacy types?
PBMs like OptumRx often unfairly focus on independent, specialty, and compounding pharmacies versus large chains. But all pharmacy types must contend with aggressive OptumRx audits. Having legal advocates levels the playing field.
Will filing OptumRx appeals or settlements impact my network contracts?
Retaliation for exercising OptumRx audit appeal rights is prohibited. We incorporate proper legal protections into OptumRx audit responses and settlements. Maintaining existing contracts is always a priority.
Can your guidance help prevent future unfair targeting by OptumRx?
Absolutely. We provide tailored compliance recommendations so pharmacies can reinforce areas prone to OptumRx audit scrutiny. Proper documentation is critical to rebutting OptumRx audit allegations.
What recourse exists if advance notice isn't provided?
Lack of proper 30-day written OptumRx audit notice violates statute in many states. We leverage penalties around insufficient notice periods into negotiation leverage for your pharmacy.
Can OptumRx audits impact DIR or BER/GER assessments?
Potentially. Depending on the scope of the OptumRx audits and the claims involved, any clawbacks should be reconciled in DIR, or BER/GER performance metrics. Our specialists ensure that any downstream OptumRx audit consequences are handled properly in your favor.
What are the costs of legal representation for OptumRx audits?
We offer flexible fee arrangements based on the scope of representation required and OptumRx audit stage. The earlier we are involved the better, as we can shape and limit OptumRx audit scope, making legal representation more effective and less costly.
%402x.svg){kind=icon}