News, Insights, Articles, and Guides

A New York pharmacy successfully defended a PBM audit with MDRXLaw's assistance. After six months of advocacy and evidence submissions, the PBM found zero discrepancies, imposed no penalties, and confirmed the pharmacy's continued network participation.

Legal obligations for psychology practices adopting AI tools under HIPAA and professional licensing rules.

The Lindsay Clancy trial highlights how telehealth decisions and clinical notes are scrutinized years later. Learn how proper medical documentation protects providers.

Risks of unvetted AI in healthcare: liability, HIPAA issues, and need for active governance.

Insurers aim to curb the No Surprises Act's IDR process, while providers use it to fight underpayment. Strengthen reimbursement strategies using data.

New York's Medicaid enrollment moratorium affects CHOWs, pending applications and pharmacy deals. How providers and buyers should structure transactions.

Healthcare payer audits can create risks far beyond repayment demands. Learn how MDRXLaw successfully overturned a 100% documentation error rate, eliminating recoupment and protecting a behavioral health provider from costly audit findings

HHS launches AERO, using AI to analyze audit data across states for better oversight.

DOJ targets healthcare fraud, focusing on telemedicine and more, using data analytics for enforcement.

AI in Therapy: Legal Guidance by MDRXLaw. Call 212-668-0200.

Lawsuit against Mayo Clinic exposes risks in AI healthcare integration, emphasizing compliance over speed.

MDRXLaw aids Maryland healthcare employers navigate new non-compete laws

Physician employment disputes can affect more than a job, potentially impacting credentialing, medical staff privileges, professional licensing, compliance, and a physician’s ability to practice. MDRXLAW helps physicians navigate these complex matters.

CMS gains new authority for federal healthcare exclusion, impacting providers.

AI's role in mental health: risks, impacts, and documentation needs.

The federal Medicaid payment freeze signals increased scrutiny of provider documentation, billing, audits, and compliance. Learn what healthcare providers should know about evolving Medicaid enforcement and regulatory risks.

Medicaid Documentation Failures Trigger $1M False Claims Act Settlement for Home Care Provider

NY DOH imposes a 6-month moratorium on new Medicaid enrollments & CHOW applications for 6 provider types, including pharmacies & LHCSAs. Read the full alert.

New York OPD is increasing enforcement against closed and non-operational pharmacies following unannounced inspections. Learn how early legal counsel can help pharmacy owners and supervising pharmacists protect their licenses and respond effectively.

Exploring how pharmacists balance legal obligations & patient communication in dispensing controlled substances.

Guidance on responding to New York OPD inquiries following pharmacy inspections and the risks of professional discipline.

GLP-1 weight-loss drugs like semaglutide and tirzepatide face increased regulatory and legal scrutiny. Providers must follow compliance, use FDA-approved drugs, document thoroughly, and ensure HIPAA adherence to minimize liability.

Learn how NY Medicaid providers can use OMIG audit protocols to stay compliant, reduce audit risk, and protect against repayment demands.

HHS-OIG's suspension of New York's Medicaid Fraud Control Unit funding signals increased Medicaid enforcement. Providers, pharmacies, and managed care organizations should prepare for audits, investigations, tighter federal oversight, and compliance risks.

Learn how MDRXLaw successfully appealed an MLTC audit, overturned a $60,000+ alleged overpayment, and reduced the final determination to $0 for a DME provider.

Independent pharmacies face substantial legal risks as manufacturers target pharmacy-to-pharmacy marketplaces for diverted drugs. Learn the DSCSA compliance red flags to avoid regulatory action, civil litigation, and criminal exposure.

Free legal sessions for new physicians on contracts, compliance, and more with MDRXLaw.

Skip costly healthcare litigation. Discover MDRXLaw's mediation for PBM terminations, audits, contracts—fast, confidential resolutions that shield compliance and revenue.

Strategize your audit response with MDRXLaw to ensure accuracy and credibility. Call us!

Ensure data security with SOC 2 audits tailored to healthcare's needs—MDRXLaw can guide you.

Uncover 5 critical overlooked clauses in healthcare payer contracts—ownership changes, disclosures, breaches—that risk terminations and fines.

2026 PBM reforms boost transparency in prescription drug pricing and oversight. Contact MDRXLaw for details.

CMS DMEPOS moratorium on medical supply companies: nationwide from Feb 27, 2026. Coverage, exceptions, compliance strategies.

Court rules AI chats not privy to legal privilege: risks highlighted.

Michigan advances bill ensuring AI claims reviews include human oversight.

Michigan physicians face a critical IMLC deadline; HB 5455 aims to maintain licensure.

2026 Michigan HB 4040 may end healthcare non-compete clauses, impacting contracts.

Step-by-step copay waiver program for NY pharmacies: Medicaid compliance, hardship affidavits, PBM safeguards. Avoid OIG penalties.

LHCSAs: OIG flags sign-on bonuses for family hires as Anti-Kickback risks. NY compliance guide + safe harbor tips.

Landmark settlement with Express Scripts

New Part D PBM reforms: CMS standards, timeline, independent pharmacy guidance.

Corporate Practice of Medicine update in New York

2026 HIPAA enforcement prioritizes real-world cybersecurity: risk analyses, vendor oversight, tested incident response, breach notices, leadership governance.

NY med spa crackdown 2026: 223 inspected, 87 cited for unlawful medicine practice. Botox, fillers, microneedling require licensed pros. Avoid fines & revocations.

OptumRx's 2026 Therapeutic Class Limits: How MDRXLaw's Proprietary Analytics Tool Empowers Pharmacies to Respond Effectively

Independent pharmacy acquisitions in 2026: Key legal risks for buyers & sellers—due diligence, PBM recredentialing, filings & more. Avoid costly pitfalls with expert guidance.

CMS launches ACCESS Model: New Medicare payments for tech-enabled chronic care in hypertension, diabetes, CKD & more. Outcome-based revenue starts 2026. Explore opportunities & compliance.

DOJ's new Health & Safety Unit escalates criminal risks for healthcare providers via FDCA & safety statutes. Learn implications & proactive steps for compliance. Free assessment available.

Discover why ISO 42001 is becoming the gold standard for responsible AI in healthcare. Reduce clinical risk, win contracts, and future-proof compliance.

CMS’s 2026 Home Health Final Rule brings retroactive revocations, payment cuts, and new documentation risks. Learn how HHAs can protect revenue and reduce legal exposure.

Healthcare AI disputes are rising. Learn how the JAMS AI Rules protect patient data, trade secrets, and resolve complex AI cases faster than traditional litigation.

Insurers are adding sweeping AI exclusions that reduce liability protection for healthcare providers. Understand emerging risks and how to review your policies.

CMMC 2.0 is now mandatory for DoD contractors (Nov 2025). Learn the 3 levels, 4-phase rollout, POA&M rules & how to stay compliant with FCI/CUI contracts.

AI fraud detection now flag payments in real-time across IRS, Medicare, and state agencies. Healthcare leaders must prepare for algorithmic enforcement today.

AI is reshaping healthcare jobs. Learn how proper training, updated roles, and smart contracts protect your practice while boosting efficiency and retention.

Generative AI in healthcare marketing risks FTC violations without strict compliance.

AI tools reshape healthcare data handling. Update your BAAs for AI compliance now. Contact MDRXLaw.

DOJ & HHS target personal healthcare fraud risks; escalating enforcement & liability for professionals.

DOJ's 2025 Troy Medicare case highlights AI misuse in healthcare, stressing compliance in AI applications.

Explore AI in healthcare: Balance innovation with HIPAA compliance, avoid public model privacy risks, embrace private deployments, and build strong governance. Contact us for expert guidance.

Explore AI in healthcare: Balance innovation with HIPAA compliance, avoid public model privacy risks, embrace private deployments, and build strong governance. Contact us for expert guidance.

Safeguard patient data in AI-driven healthcare: Explore HIPAA encryption essentials, real cases like M.D. Anderson, and 6 steps for compliance. Expert guide for providers.

Healthcare AI in M&A requires thorough due diligence on compliance, data privacy, vendor contracts, and state regulations to identify liabilities and ensure HIPAA compliance.

Learn how AI is reshaping healthcare claims, impacting provider payments and audits, and the strategic responses required.

Civilian contractors need DoD sponsorship for security clearance, undergo background checks, and can appeal denials; clearances are vital for defense work.

Attorney-client privilege protects healthcare providers' legal communications but can be waived by forwarding emails, using public AI tools, or sharing without caution.

Out-of-network providers can use ADR and mediation to resolve insurer disputes privately, efficiently, and cost-effectively while maintaining independence.

NY’s new Certificate of Need rules ease regulatory burdens for small healthcare providers, raising thresholds and expediting routine facility improvements

$1.9M pharmacy audit reduced to $200K. Our team uses AI-enabled analysis and decades of experience to fight PBM audits and protect your pharmacy's bottom line.

The February 2024 versions of SF 85, 85P, 85P-S, and 86 are now required for all background investigations. Earlier forms are no longer accepted by DCSA.

New BIS Affiliates Rule: Foreign entities 50%+ owned by listed parties now face automatic export restrictions. Ownership, not just listing, triggers controls.

Omnicare’s Bankruptcy After a Near-$1b FCA Judgment: What Pharmacies, LTC Operators, and PBMs Need To Do Now

MDRXLaw secures $7 million arbitration victory, setting a precedent for pharmacy reimbursement fairness.

2026 CMS Rule updates RPM billing, enhancing provider flexibility and patient access.

Pharmacies risk legal exposure by using consultants for audits. Attorney-client privilege, legal strategy, and representation are critical in PBM investigations.

DOJ and HHS relaunch FCA task force, signaling stricter, proactive healthcare fraud enforcement—Medicare Advantage, kickbacks, and data analytics in focus.

Pharmacies face rising audits and legal risks for false prior authorizations. Protect now.

NY pharmacies can use CoverMyMeds for Medicaid ePAs starting summer 2025. Learn how to stay compliant and streamline approvals with expert legal guidance.

Proudly recognized in the Chambers Spotlight New York 2025 Guide, MDRXLaw continues to set the standard for excellence in healthcare law.