Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
How to Respond to a PBM Audit Letter
A PBM audit letter starts a recoupment clock. What a pharmacy does in the first days shapes the demand, the appeal, and whether one audit becomes a termination.
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Texas Moves to Rein in Ketamine Therapy: And Other States are Likely Next
The regulatory environment surrounding ketamine therapy is entering a new phase of maturity and enforcement. Recently, the Texas M…
California Hospice Fraud Crackdown: What it Means for Providers & How to Protect Your Business
California’s hospice fraud crackdown is only the beginning of what CMS and Medi-Cal regulators have claimed will be many more case…
The WISeR Model: A New Era of Prior Authorization and Audit Risks for Wound Care
On January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) officially launched the Wasteful and Inappropriate Service…
OMIG Audit Defense New York: What the 2026 Work Plan Means for Providers
Every year, the New York Office of the Medicaid Inspector General (OMIG) releases its Work Plan outlining enforcement priorities.…
DOJ Targets Ketamine Clinics: Federal Charges Lead to Prison and Probation for Two Providers
The explosion in demand for ketamine-assisted psychotherapy (“KAP”) has garnered significant media attention over the past few yea…
Clashing with Caremark: $45,000+ in Clawbacks Fully Reversed for Florida Pharmacy
Health Law Alliance helped n independent pharmacy in Florida reverse over $45,000 in clawbacks.
From Minor PBM Audit Finding to Major Liability: How Small Issues Trigger Big Consequences
Pharmacies often approach a PBM audit with the understanding that small discrepancies and modest recoupments are simply part of do…
HLA’s Latest PBM Win Highlights the Dangers of Inventory Discrepancies
Inventory discrepancies are one of the first things PBMs look for during an audit. Even minor clerical errors like entering the in…
PBM Member Denial Audit Findings: A Growing Threat to Pharmacies
Pharmacies undergoing a Pharmacy Benefit Manager (PBM) audit are typically prepared to address inventory discrepancies and documen…