Legal Insights

PBM audits can leave pharmacies facing exaggerated findings, steep recoupments, and even network termination. With the right strategies and legal support, pharmacies can successfully challenge unfair results and protect their business.

PBM audits can be disruptive, costly, and often triggered by high prescription volumes, dispensing irregularities, or claim activity. Pharmacies can reduce risks through strong documentation, compliance, and legal support to challenge unfair findings and protect network status.

Without further congressional action, COVID-19 era telehealth flexibilities are set to expire on September 30, 2025. Read more to learn about what’s set to change and key guidance for telehealth providers to prepare to adapt to pre-pandemic coverage rules.

On August 28, 2025, the US Department of Health and Human Services’ Office of the Inspector General published a report outlining billing data trends for remote patient monitoring (RPM) in Medicare, renewing its calls for increased oversight into RPM services. Learn more about the reports key findings.

 In a recent victory, our attorneys at Health Law Alliance achieved a full reversal of Optum’s termination of a New York pharmacy. Read about how HLA fought tirelessly to rebut Optum’s allegations and how Health Law Alliance can defend your pharmacy from an unjust termination.

For DME suppliers, a notice from CMS can be daunting, especially when you're trying to figure out the difference between a TPE, SMRC, and UPIC. Each of these audit contractors has a different mission, scope, and level of risk for your business. Our latest blog post breaks down the "alphabet soup" of CMS audits, explaining what each entity does, what they look for, and how you should respond when they contact you. Protect your business by understanding who is on the other side of the audit.

In a CMS audit, your documentation is your only defense. A missing signature or an incomplete progress note can lead to a costly overpayment demand. Is your record-keeping system truly protecting you? This article provides a blueprint for creating an audit-proof documentation system. We cover everything from intake checklists to monthly note requirements for wound care supplies, helping you ensure every claim is fully supported and ready for scrutiny.

Health Law Alliance is proud to announce a major victory in federal court, where it successfully secured the immediate lifting of a DEA suspension against a Florida community pharmacy, restoring its full authority to dispense controlled substances. This outcome ensures uninterrupted patient care and underscores the firm’s commitment to protecting healthcare providers from government overreach.

Federal enforcement actions are increasingly focused on remote patient monitoring (RPM) services. In this article, we break down two recent settlements involving RPM companies—Health Wealth Safe and Capital Health—and discuss key compliance takeaways for telehealth providers.