Facing an OptumRx audit? Without the right defense, your pharmacy risks costly penalties and operational disruptions. At Health Law Alliance, we specialize in protecting pharmacies from aggressive audits and Fraud, Waste & Abuse investigations. Our expert legal team reduces risks, resolves issues quickly, and helps you stay compliant.
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Healthcare Specialty Attorneys and Consultants - Health Law Alliance specializes in healthcare law and is dedicated to defending healthcare providers and their licenses from overreach.
Tenacious Defense - Health Law Alliance has gone after – and beaten – much bigger opponents. When faced with a seemingly daunting legal issue, our attorneys are the ones to call.
Proven Track Record - The attorneys at Health Law Alliance have a demonstrated track record of success against the most aggressive government regulators and industry behemoths.
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.
Speak to an experienced attorney today at no-cost to evaluate your situation and discuss how we can help.
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