Legal Insights

Health Law Alliance successfully reversed pending terminations for 7 New York pharmacies. Read more about how our PBM audit team achieved this stunning reversal.

Ketamine marketing is under increasing regulatory scrutiny, with providers facing risk over claims, off-label promotion, and patient targeting. Even well-intentioned messaging can trigger audits or enforcement if it crosses compliance lines.

PBMs are ramping up audit pressure in 2026, now targeting provider-patient relationships to justify recoupments and even network terminations. Without precise documentation, even well-established prescriptions can put pharmacies at serious financial and operational risk.

This week, Health Law Alliance achieved full reversal of a PBM credentialing denial for a New York pharmacy—mere weeks after it received a termination notice. Read more to learn how Health Law Alliance’s tireless advocacy can help your pharmacy in credentialing disputes.

PBMs are increasingly targeting pharmacies over their role in the prior authorization process, using vague allegations to justify massive recoupments and even terminations. Without airtight documentation and clear procedures, even compliant pharmacies can face serious financial and legal risk.

Ketamine providers face growing regulatory scrutiny across prescribing, marketing, and care models. A focused compliance checklist is essential to reduce risk and stay ahead of enforcement.

CMS’s 2026 reimbursement overhaul for skin substitutes signals more than cost control. It marks a sharp rise in audits, enforcement, and compliance risk for wound care providers. Clinics relying on advanced wound care billing should prepare now, as regulators and payers intensify scrutiny across documentation, utilization, and financial relationships.

FDA scrutiny of peptide compounding is intensifying, and 503A pharmacies are squarely in focus. If you compound, source, or dispense peptides, now is the time to assess your regulatory exposure before enforcement escalates.

Wound care is now an enforcement priority. The 2025 fraud takedown targets skin substitute billing, graft utilization, and Medicare compliance.