Q. Should a healthcare provider consider engaging
counsel to assist with audit responses?
Health care providers often ask whether they should engage legal
counsel to assist with audit responses. The answer depends on
the level of risk. When an audit is meaningful, involves significant
financial exposure, or references fraud, engaging experienced
health care counsel should be strongly considered.
For example, if an operating pharmacy receives a Civil
Investigative Demand alleging false claims or other unlawful
activity, counsel should be involved immediately. At that stage,
the potential consequences are too serious to navigate without
legal guidance.
On the other hand, a routine PBM audit involving a small dollar
amount may not justify the cost of outside counsel. The decision
is a practical one. As financial, operational, or personal exposure
increases, so does the need for legal representation.
Counsel plays a critical role in controlling the audit process.
Attorneys manage communications with auditors, reducing the
Pharmacy Compliance,
Audits, & Regulation
Guidance for Healthcare Providers
Benefits of Engaging Counsel
• Creates & Manages a Privilege Log
• Bates Stamps & Organizes Documents
• Establishes a Secure Data Room
• Applies a Litigation-Style Framework
Pharmacy Compliance,
Audits, & Regulation
Guidance for Healthcare Providers
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