A prescription can be valid while the claim submitted for it is wrong. For pharmacies, the connection between the directions, quantity, days’ supply, and refill date is where a dispensing decision can become a reimbursement problem. The CVS insulin settlement gives New York pharmacies a concrete reason to review that connection. It concerns more than […]
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Pharmacy and PBM Audit Trends in New York for 2026
For a New York pharmacy, a PBM audit is both a documentation problem and a payment problem. The audit team may ask about a small group of prescriptions, while the proposed chargeback threatens money the pharmacy needs for inventory and payroll. In 2026, the useful question is not simply whether pharmacy benefit managers are auditing […]
Adult Day Care and CDPAP Kickback Investigations in New York
An adult day care can deliver real services and still face questions about how its participants were recruited. A CDPAP business can process genuine care hours and still face scrutiny over payments to someone who brought in consumers. In a kickback investigation, the government examines the payment arrangement as well as the underlying care. For […]
CDPAP Fraud Investigations in New York: What Caregivers and Providers Should Know
A CDPAP fraud investigation in New York may focus on whether Medicaid paid for care that actually occurred, whether the hours were authorized, or whether someone received money for arranging a patient’s participation. Caregivers, consumers, payroll staff, and business owners may have different responsibilities, even when investigators are reviewing the same claims. A payroll error […]
NYC Adult Day Care Raids: Medicaid Fraud Investigation and Legal Defense
Federal authorities conducted coordinated law enforcement operations at adult day care facilities across New York City on October 20, 2026, as part of ongoing investigations into suspected Medicaid fraud. The operations involved facilities in Brooklyn, Queens, and Staten Island and have raised serious concerns among adult day care operators and other Medicaid-funded healthcare providers. According […]
New York Medicaid Managed Care Audits: Why Providers Are Being Reviewed More Closely
A Medicaid managed care audit in New York may start with a health plan’s Special Investigation Unit, an outside audit vendor, or the New York State Office of the Medicaid Inspector General. The letter may ask for medical files, orders, service logs, billing support, employee information, or records tied to a defined group of claims. […]
