Common Problems Faced by Pharmacies in PBM Audits: Insights into CVS Caremark, OptumRx, and Express Scripts Pharmacy Benefit Managers (PBMs) such as CVS Caremark, OptumRx, and Express Scripts play a pivotal role in managing prescription drug benefits for millions of Americans. While they help control costs and streamline the drug distribution process, their audits can […]
Healthcare Law
Understanding PBM Services: A Closer Look at CVS Caremark, Express Scripts, and Optum Rx
Pharmacy Benefit Managers (PBMs) are powerful intermediaries in the healthcare system, playing a crucial role in the administration of prescription drug benefits. PBMs manage the prescription drug portion of health insurance plans, acting as middlemen between insurance providers, pharmacies, and drug manufacturers. They negotiate prices with drug manufacturers, establish formularies, and determine the reimbursement […]
Physical Therapy Audits, Billing, and Compliance in New York
In New York, physical therapy practices play a critical role in the healthcare system, providing essential treatments that help patients recover from injuries, manage chronic conditions, and improve their overall quality of life. However, with the increasing complexity of healthcare regulations and the growing scrutiny from federal and state agencies, physical therapy practices face significant […]
Why Nurses Should Not Speak with HR or Management When Accused of Misconduct
In the high-stakes world of healthcare, nurses are entrusted with immense responsibility. Their actions, decisions, and behavior are constantly scrutinized, not only by patients and colleagues but also by their employers. When a nurse is accused of misconduct on the job, it’s a situation that can quickly spiral out of control. The instinct to defend […]
Billing Medicaid Under Someone’s Name: What You Need to Know
Medicaid is a vital healthcare program that provides coverage for millions of low-income individuals and families across the United States. For healthcare providers, billing Medicaid accurately and legally is critical to maintaining compliance and avoiding severe penalties. One area that often causes confusion is billing Medicaid under someone’s name, particularly when it comes to certified […]
Dental Billing and Audits in New York: Navigating Medicaid and Medicare
Navigating the intricacies of dental billing and compliance in New York is essential for maintaining a successful and legally sound dental practice. With the state’s stringent regulations and oversight from bodies such as the Office of the Medicaid Inspector General (OMIG) and the Medicaid Fraud Control Unit (MFCU), understanding the billing landscape is crucial. This […]
