Anthony Mahajan

Founding Partner
Anthony Mahajan, a seasoned leader with over two decades of crisis-management experience, specializes in federal and state government disputes. As a former, highly decorated federal prosecutor and top executive for major healthcare companies, he is recognized for his insightful approach in achieving successful resolutions within the complex healthcare system.

Anthony Mahajan

About

Anthony Mahajan is hailed for his leadership and more than two decades of crisis-management experience guiding corporate and individual clients through the most significant and high-stakes challenges that can arise, with particular expertise in federal and state government disputes. Clients large and small turn to Anthony for the perspective and insight he offers as a decorated former federal prosecutor and top executive for the largest healthcare companies in the world. That background is valued by clients because it facilitates dialogue around the overwhelming tensions and competing pressures inherent in our healthcare system, often leading to successful settlements and resolution. If that fails, however, Anthony is recognized by peers and adversaries alike as a ferocious trial attorney and courtroom tactician.

Prior to founding the Health Law Alliance, Anthony was employed by a healthcare boutique as Chair of the White Collar & Government Investigations practice group. As an Assistant U.S. Attorney with the Department of Justice, Anthony served as a federal prosecutor in the District of New Jersey for nearly nine years, where he led the investigation and prosecution of healthcare-related crimes, receiving accolades as the Attorney General Award nominee (D.N.J. 2015), Director’s Award nominee (E.D.N.Y. 2016), Federal Executive Board Award recipient (2015), Federal Law Enforcement Foundation “Prosecutor of the Year” Award recipient (2016), and N.J. Law Narcotic Enforcement Officers’ Association Award recipient (2010).

Anthony also served as Chief Compliance Officer and Executive Leadership Team member for UnitedHealth Group, the parent company of Optum and United Healthcare, where he oversaw teams of legal and compliance professionals to support operations that generated $300 billion in annual revenue. As Chief Counsel and Vice President for McKesson Corp, Anthony oversaw independent and chain pharmacy controlled substance monitoring, and provided regulatory and compliance advice to McKesson’s businesses, including CoverMyMeds, on a variety of issues, including prior authorization, inventory management, contract manufacturing, drug importation, sales and marketing, anti-kickback, manufacturer promotions, discounts and rebates, drug price reporting, and restricted product distribution. Anthony earned his Juris Doctor from Fordham University School of Law, cum laude, where he was an editor for the Fordham Law Review.

Anthony graduated from Rutgers University, summa cum laude, with a B.A. in Political Science. His personal interests include not pondering the meaning of life, just living it.

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Anthony Mahajan

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PBM Audit Triggers

Common PBM Audit Triggers and How to Avoid Them

Guide independent pharmacies in recognizing and proactively managing specific behaviors and operational trends that commonly lead to PBM audits. This article will offer a detailed watchlist of PBM audit triggers and present practical, actionable steps for minimizing risks of audit findings and compliance issues.
Charges Declined

Department of Justice Declines to Prosecute HLA Client for Alleged $6M Fraud

After the Department of Justice threatened to indict our client for involvement in an alleged $6M healthcare fraud, we stood firm and our tenacious advocacy ultimately convinced the Strike Force to decline prosecution, representing a complete win for HLA's client.
PBM Agreements

Enforcement of Arbitration Clauses in PBM Network Agreements: A Guide for Pharmacy Owners

This article explains arbitration clauses in Pharmacy Benefit Manager (PBM) network agreements, outlining when these clauses can be enforced and how they affect dispute resolution for pharmacies.
PBM Lawsuit

HLA's Lawsuit Against Optum Achieves Return of Hundreds of Thousands of Dollars in Withheld Reimbursement

Health Law Alliance's lawsuit against Optum has resulted in the immediate release of hundreds of thousands of dollars in reimbursement that Optum unlawfully refused to release to our client prior to being sued.
Case dismissed

HLA Attorney Anthony Mahajan Wins Dismissal of False Claims Lawsuit Against Oncology Dispensing Practice

Health Law Alliance's Anthony Mahajan is pleased to announce the complete dismissal of a lawsuit brought on behalf of the federal government against a cancer care provider for the submission of false Medicare claims for oncology drugs.
PBM Termination

HLA Files Emergency Texas Lawsuit Against Optum PBM Audit Termination

Health Law Alliance announces the filing of an emergency lawsuit in federal court for the Northern District of Texas, Dallas Division, to stop Optum's termination of an independent pharmacy that dispensed medications on telemedicine prescriptions and force Optum to comply with federal and state "prompt payment" laws that prohibit withholding of reimbursement.
PBMs Condemned

FTC Issues Interim Report Condemning Anticompetitive PBM Practices

The top Pharmacy Benefit Managers (PBMs) are condemned by the FTC for manipulating the healthcare system to generate significant profits, thereby inflating drug costs and overcharging patients, particularly for critical medications like cancer drugs.
Ozempic Seizure

Seized Ozempic Shipments Highlight Rising Demand and Safety Concerns

Ozempic, a well-known medication for type 2 diabetes, has gained popularity for its off-label use in weight loss, leading to increased scrutiny by authorities. Recently, U.S. Customs and Border Protection (CBP) officers in Cincinnati seized several shipments of the drug, underscoring the growing demand and associated risks.
Ozempic Shortage

A Golden Opportunity for Compounding Pharmacies: Navigating the Ozempic Shortage

There has never been a more fortunate time for compounding pharmacies looking to capitalize on the "Gold Rush" of Ozempic. Due to the forecasted limited supply of the brand name drug, the FDA has put Ozempic on the shortage list, which will allow for a more accommodating set of rules regarding compounding and distribution of semaglutide-based drugs.
Ozempic Compliance

Semaglutide Compliance Program: A Must Have

The semaglutide industry is relatively new, and significant regulatory enforcement typically lags by at least two years. Accordingly, all participants involved in the semaglutide supply chain should implement well-designed compliance programs now to reduce the risk and severity of future regulatory action.
Ozempic Compliance

Federal Prosecutors Focus on Ozempic Violations

Intense semaglutide demand has now drawn the attention of regulators beyond the Food & Drug Administration (FDA) and state boards. Last month, a woman was charged by federal prosecutors with violations of criminal law related to misbranded and adulterated weight loss drugs. This prosecution marks the first of many to come.
Prior Authorization

Express Scripts FWA Investigative Alert: Crackdown on CoverMyMeds Provider Accounts

Express Scripts is targeting prior authorization Fraud, Waste & Abuse involving the use of CoverMyMeds provider accounts by pharmacies. Pharmacies and physicians beware.
DEA Applications

Increased Scrutiny for DEA Registration Applications

DEA registration applications are receiving increased scrutiny as DEA turns its sights on providers and pharmacies to curtail controlled substance misuse and abuse. Applicants can and should take steps to ensure the registration process moves as quickly and smoothly as possible.
Audit Enforcement

Medicare Advantage Cuts to Increase PBM Pressures

Insurers have bet big on Medicare Advantage, but the government is slowly cutting back. Faced with rising medical loss ratios and CMS reimbursement cuts, payors and their PBMs are planning to make up those losses by increasing pharmacy claims audits and unilateral recoupments.
Board investigations

Pharmacy Alert: Texas Board of Pharmacy Investigations

Texas pharmacies are facing increasing scrutiny by the Board of Pharmacy, which is working closely with the DEA and other federal agencies, to investigate regulatory violations and Medicaid claims.
Ozempic profits

Semaglutide Demand is Skyrocketing: Ozempic Opportunities

As summer approaches, soaring demand for weight-loss drugs like Ozempic, Wegovy, and semaglutide compounded copies, will exacerbate the existing short-supply, raising both consumer prices and pharmacy profits for those positioned to capitalize.
Charges dropped

MFCU Agrees Not to Charge HLA Client Following PBM Audit Referral

PBM audits must be handled correctly or severe consequences may result. In this case, HLA was able to persuade prosecutors not to file criminal charges against the pharmacy's owner, but a subsequent civil resolution still involved harsh penalties. It could have been far worse.
Case dismissed

HLA Wins Dismissal of Criminal Charges After PBM Audit

Health Law Alliance has successfully challenged OptumRx's termination decisions for numerous pharmacies, ensuring they can continue to operate and serve their communities. These victories highlight the firm's expertise in healthcare law and its dedication to protecting pharmacy clients from unjust PBM actions.
Pharmacy Audits

HLA's Coffey Appointed by Attorney General

HLA's Nancy Coffey, a former government official and healthcare expert, has been appointed to serve a three-year term as an independent pharmacy monitor for the Commonwealth of Massachusetts.
SafeGuard audits

SafeGuard Audits: Don't Let CMS's Contractor Infringe Your Rights

Providers need to know their rights when it comes to investigations and audits by CMS UPIC contractors, such as SafeGuard and Qlarant. These investigators are private citizens, with no more authority or power of law than anyone else. Yet, they often employ traditional law enforcement techniques. Don't be fooled.
Billing fraud

Walgreens Must Face Lawsuit Based on False Prior Authorizations

The federal government continues to bring enforcement actions relating to false prior authorizations given the high-priced medications typically involved. In this case involving Walgreens, we take a deeper dive into potential theories of liability and the use of civil investigative demands and subpoenas in healthcare fraud cases.
Inventory prosecution

DOJ Maintains Focus on Inventory Shortfalls

Department of Justice prosecutors continue to file numerous cases against pharmacies and their owners for inventory shortfalls and other discrepancies. These cases arise out of referrals by government contractors following a pharmacy audit, and often involve severe potential consequences.
Inventory audits

HHS-OIG Prioritizes 2024 Pharmacy Audits

Based on a recent announcement, the federal government (HHS-OIG) will be prioritizing audits of pharmacy claims in 2024. This further signals that pharmacy audits from all angles are on the rise.
DEA regulations

DEA's Dangerous New Agenda

Although DEA has long targeted wholesalers as the "choke-point" for stemming diversion, the Agency has now shifted its focus to downstream physician and pharmacy registrants. Providers who thought they understood DEA risk need to revisit their planning because the enforcement paradigm has changed dramatically.
Audit response

PBM Audit Response Summary

PBM audits can be resolved successfully, but more frequent and aggressive audits will require careful planning. Providers should avoid reactive behavior. Strategic planning for audit resolution should be made from audit inception to proactively manage audit risk effectively.
Firm Capabilities

Firm Overview & Capabilities

In this article we profile the The Health Law Alliance, a specialized healthcare boutique with a team of experts in government investigations, PBM audits, payor disputes, licensing board matters, and regulatory advice. Industry peers note the extensive legal experience of the firm's founding partner and the diverse expertise of the team, positioning the firm to provide strategic and pragmatic solutions for clients facing challenges in the healthcare sector.
Off-Label Prescribing

Off-Label Prescribing and Dispensing: Ozempic, Wegovy, and Other Medications

Anthony Mahajan delves into the intricacies of off-label prescribing and dispensing for medications such as Ozempic, Wegovy, and Rybelsus. Mahajan discusses legal nuances applicable to manufacturers, physicians, and pharmacists, offering practical guidance for healthcare providers to manage off-label exposure effectively.
Federal Investigation

Federal Investigation for OTC Cards is Expanding

Federal prosecutors are expanding a healthcare fraud investigation, charging New York pharmacy owners and employees for violations related to OTC card practices. Health Law Alliance, led by Anthony Mahajan, emphasizes the severity of charges, urging providers to act promptly to limit exposure.
NYRx Transition

NYRx Transition May Increase Medicaid Program Risk

The transition of Medicaid pharmacy benefit to NYRx in New York brings increased dispensing fees but also heightened audit and enforcement risks, with potential scrutiny from OMIG and HHS-OIG, warns Health Law Alliance led by Anthony Mahajan.
Regulatory Threats

Semaglutide Compounding Pharmacies Subject to Increasing Regulatory Threats

Semaglutide compounding pharmacies face regulatory threats as state boards interpret statutes restrictively; Health Law Alliance, led by Anthony Mahajan, emphasizes broader permissions, countering misinterpretations.
Unlawful Seizure

Health Law Alliance Recovers More than $20M Unlawfully Seized from Clients by Financial Institutions

Health Law Alliance, with Anthony Mahajan at the helm, recovers $20M+ unlawfully seized by financial institutions, highlighting potential illegality in account restraints and urging clients to seek immediate counsel for asset freezes.
Semaglutide Lawsuits

Novo Nordisk’s Recent Lawsuits to Stop Semaglutide Compounding are Baseless

Anthony Mahajan, an attorney at Health Law Alliance, contends that Novo Nordisk's recent lawsuits against Florida compounding pharmacies to stop semaglutide compounding are baseless attempts to limit market availability and intimidate compounders. Mahajan highlights the legality of semaglutide compounding under Sections 503A and 503B of the FD&C Act, emphasizing that Novo's arguments lack substance and should not intimidate semaglutide compounders who play a crucial role in meeting patient needs.
Audit Defense

How PBM Audits Can Provoke Government Scrutiny

Health Law Alliance's Anthony Mahajan discusses the potential outcomes and strategies related to Pharmacy Benefit Manager (PBM) audits, emphasizing the importance of understanding the intersection between government enforcement actions and PBM audits. With unmatched experience in PBM audit defense, Mahajan highlights the firm's achievements in resolving cases involving inventory discrepancies and government investigations, offering comprehensive solutions to protect clients against potential liabilities.
Fraud Defense

Federal Prosecutors Drop Criminal Charges Against Specialty Pharmacy Owner Relating to False Prior Authorizations

Federal prosecutors have decided not to prosecute the CEO of a Florida specialty pharmacy, represented by Health Law Alliance's Anthony Mahajan, in connection with an alleged healthcare fraud scheme involving Evzio. The successful defense resulted in an innovative $1.3 million civil settlement, avoiding criminal charges and exclusion from federal programs.
Disclosure Success

OIG Accepts Healthcare Fraud Self-Disclosure by Physician and Physician Group

Health Law Alliance, led by Anthony Mahajan, announces the acceptance of a self-disclosure by OIG on behalf of Shore Orthopaedic University Associates, limiting liability to $333,645.83 for Medicare claims involving an unapproved code for Fluid Flow. The success underscores Health Law Alliance's expertise in OIG self-disclosures and the intricate decision-making process surrounding voluntary disclosures.
Disclosure Success

OIG Accepts Healthcare Fraud Self-Disclosure by Pharmacy

Health Law Alliance, under Anthony Mahajan's guidance, reports the successful acceptance of a self-disclosure for Delmar Pharmacy by OIG following a PBM audit identifying Humira dispensing discrepancies. The pharmacy's collaborative decision to disclose limits liability to $218,129.26, emphasizing Health Law Alliance's expertise in PBM audit defense and OIG self-disclosures.
Audit Victories

Inventory Shortfall Case Studies

Health Law Alliance, under Anthony Mahajan's leadership, celebrates favorable outcomes in federal and state cases involving inventory shortfalls, showcasing their expertise in PBM audit defense. Successful dismissals of criminal charges and reduced civil settlements highlight Health Law Alliance's strategic approach in resolving cases stemming from PBM audits.
Audit Considerations

Key PBM Audit Considerations

Health Law Alliance provides an overview of the PBM audit process and relevant background for providers who suddenly find themselves facing arbitrary recoupments and potentially devastating network consequences. PBM audits are not random or happenstance, and providers must understand the role of Special Investigative Units (SIUs) and the potential for broader liability beyond the audit itself to successfully manage these risks.
Inventory Defense

Defending Inventory Shortfalls

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.
Audit Opportunities

Potential Windows of Opportunity

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.
Audit Resolution

OIG’s Self-Disclosure Protocol

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.
Audit Help

When to Seek Help

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.
Audit Defense

Audit-Related Prosecutions Rise Sharply

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.