Legal Insights

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.

We examine the complex requirements and risks associated with informed consent for telehealth providers. The article provides actionable advice on navigating the regulatory landscape and practical steps to ensure legal compliance and patient safety.

Telemedicine business models may prompt regulatory scrutiny, including board investigations. In this case, HLA's experienced defense attorneys successfully resolved a three-year, multi-state investigation with no licensing or other implications.

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.

Health Law Alliance successfully reversed Optum’s termination of a Texas pharmacy from its network, protecting the pharmacy from severe financial and reputational damage. Our healthcare attorneys used strategic legal expertise and negotiations to overturn the decision, ensuring the pharmacy could continue serving patients. This victory highlights our dedication to strong advocacy and proven results.

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.

The U.S. Justice Department is investigating allegations of Medicare fraud, where senior citizens' ID numbers were used to order unwanted COVID-19 test kits. Learn more about the ongoing investigation and its implications.

Health Law Alliance is pleased to announce that Optum recently agreed to reverse its network termination of a Texas pharmacy client despite significant claim discrepancies based on inventory shortages, patient denials, and other alleged violations of the terms and conditions of the Provider Manual and network enrollment agreements.

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.