Legal Insights

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.

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.

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.

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.

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.

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.

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.

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.