Our PBM audit defense team is second to none when it comes to getting results for our independent pharmacy clients. This week, Health Law Alliance secured a victory on behalf of a Florida pharmacy following a Caremark audit seeking more than $45,000 in alleged overpayments. During the audit, Caremark alleged that the pharmacy had failed to provide sufficient proof of copayment collection, prescription delivery, and patient-prescriber relationships—even though the pharmacy provided all of the required documentation during the audit.
After Caremark issued its audit findings, our team moved quickly to assess the allegations and develop a targeted appeal strategy. We challenged the audit’s conclusions head on, leveraging the pharmacy’s documentation and a focused legal framework to dispute the claimed deficiencies. The result? A full reversal of all audit findings, with Caremark rescinding all of its clawbacks.
PBMs want pharmacy owners to believe that their audit findings are final, but our attorneys know that a notice of findings is only the first step in the appeal process. We regularly fight back against unjust findings from some of the largest PBMs in the nation, from unsubstantiated affiliation allegations to vague prior authorization concerns. With the right strategy and advocacy, pharmacies can successfully push back against PBMs’ aggressive recoupment tactics, protecting their bottom line, reputation, and network status.
Health Law Alliance continues to deliver results for pharmacies facing PBM audits and related enforcement actions nationwide. If your pharmacy has received adverse audit findings, there is no better team to have on your side. Contact us today and see how we can help you.
MORE ARTICLES BY CATEGORY
OMIG Audit Defense New York: What the 2026 Work Plan Means for Providers
Every year, the New York Office of the Medicaid Inspector General (OMIG) releases its Work Plan outlining enforcement priorities. The 2026 plan sends a clear signal that Medicaid providers in New York are entering a far more aggressive enforcement environment.
Read More >>PBM Member Denial Audit Findings: A Growing Threat to Pharmacies
Pharmacies often approach a PBM audit with the understanding that small discrepancies and modest recoupments are simply part of doing business. In today’s enforcement landscape, that assumption is no longer safe.
Read More >>From Minor PBM Audit Finding to Major Liability: How Small Issues Trigger Big Consequences
Pharmacies often approach a PBM audit with the understanding that small discrepancies and modest recoupments are simply part of doing business. In today’s enforcement landscape, that assumption is no longer safe.
Read More >>HLA’s Latest PBM Win Highlights the Dangers of Inventory Discrepancies
Inventory discrepancies are one of the first things PBMs look for during an audit. Even minor clerical errors like entering the incorrect NDC or failing to return a medication to stock can snowball, creating major financial risks that could place your pharmacy in jeopardy.
Read More >>
