Legal Insights

Health Law Alliance addresses the complexities of defending against inventory shortfalls in the context of PBM audits, emphasizing the common sources of discrepancies and potential legal implications. The article underscores the importance of a well-organized defense strategy to limit liability and navigate potential consequences for providers facing network suspension, administrative proceedings, civil lawsuits, or even criminal charges arising from inventory management errors.

Health Law Alliance, specializing in PBM audit defense, highlights the potential benefits of discrepant PBM audits as early warnings for broader government investigations. The article underscores the importance of strategic planning, including OIG self-disclosures, to reduce liability for providers facing PBM audits and government inquiries.

Healthcare providers facing PBM audits can leverage the OIG's Self-Disclosure Protocol (SDP) to reduce liability by self-reporting potential violations of laws, benefiting from reduced penalties and additional incentives. The complex SDP process, involving full disclosure and liability limitations, underscores the importance of seeking guidance from experienced healthcare defense counsel.

Providers facing PBM audits must decide whether to rely on internal staff or seek audit counsel from experienced attorneys, particularly when concerns about audit scope or risk factors arise. HLA's attorneys, with prosecutorial background, offer crucial insights and protection against potential legal consequences during pharmacy audits.

Federal prosecutors are now pursuing felony charges under Section 1035 for false statements in pharmacy audits, extending the risk of criminal prosecution for healthcare providers. Recent cases highlight the importance of legal counsel, such as HLA's experienced attorneys, to safeguard against potential legal consequences.