Tesch Leigh West on Health Care Providers

‘One Big Beautiful Bill Act’: Key Final Medicaid Changes Explained

The One Big Beautiful Bill Act was signed into law on July 4 and includes significant changes to the Medicaid program, particularly with regard to state and federal financing for the program. This LawFlash provides a...more

7/10/2025 / Centers for Medicare & Medicaid Services (CMS) , Federal Funding , Health Care Providers , Healthcare Reform , Immigrants , Medicaid , New Legislation , Regulatory Requirements , State and Local Government

Falling Stars Ratings in Medicare Advantage Lead to Meteoric Payment Losses

The enormous impact of Medicare Stars Ratings on payments received by Medicare Advantage plans cannot be overstated. And with billions of dollars in bonus payments at stake, it may come as no surprise that stringent standards...more

12/2/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

Medicare Advantage: Managed Care Compliance in 2024

The Medicare program is broken down into four parts. Part A covers the cost of healthcare items and services provided during inpatient hospital stays as well as skilled nursing facility, hospice, and some home health care....more

3/21/2024 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Medicare , Medicare Advantage , Prescription Drugs

Once Again #1: Health Care Fraud Leads DOJ False Claims Act Recoveries in 2024

The US Department of Justice (DOJ) Civil Division released its annual fraud statistics on February 22, highlighted by False Claims Act (FCA) settlements and judgments exceeding $2.68 billion in fiscal year 2023. DOJ released...more

2/26/2024 / Department of Justice (DOJ) , False Claims Act (FCA) , Health Care Providers , Healthcare Fraud , Kickbacks , Medicare Advantage

Medicaid Unwinding: CMS to Withhold Federal Medicaid Funding from Noncompliant States

Since our publication on disenrollments caused by the “unwinding” of Medicaid’s continuous enrollment condition, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on December 6, 2023...more

12/20/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Interim Final Rules (IFR) , Medicaid

Don’t Wait to Review CMS’s Proposal to Implement Minimum Managed Care Appointment Wait Times

The Centers for Medicare & Medicaid Services (CMS) proposed on April 23, 2023 two rules that would affect Medicaid managed care: Ensuring Access to Medicaid Services (CMS 2442-P) and Medicaid and Children’s Health Insurance...more

6/29/2023 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Managed Care Contracts , MCOs

Saved by the Bell? Telehealth Remains Largely Intact When PHE Ends

Healthcare providers are scrambling to understand the impacts of the May 11 expiration of the COVID-19 public health emergency (PHE). Luckily for most telehealth providers, the outlook of their operations post-PHE is...more

5/10/2023 / Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Health Care Providers , OIG , Public Health Emergency , Telehealth , Telemedicine

CMS’s Final RADV Rule Announces No Extrapolation Methodology, No FFS Adjuster

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs) and...more

2/24/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

DOJs False Claims Act 2022 Year in Review Shows Significantly Lower Recoveries in the Healthcare Industry

The US Department of Justice’s (DOJ’s) Civil Division released its annual fraud statistics on February 7, covering fiscal year 2022. Settlements and judgments under the False Claims Act (FCA) exceeded $2.2 billion in the...more

2/10/2023 / Anti-Kickback Statute , Department of Justice (DOJ) , Enforcement Actions , False Claims Act (FCA) , Health Care Providers , Healthcare Fraud , Qui Tam , Whistleblowers

CMS’s Delayed Final Rule on the FFS Adjuster Gets Delayed . . . Again

The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation...more

11/14/2022 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Final Rules , Health Care Providers , Medicare Advantage Organizations (MAOs)

February Fast Break Recap: Risk Adjustment and Liability

Last month, we had an engaging Fast Break session covering the growing importance of risk adjustment in various health insurance programs and novel government theories of liability associated with risk adjustment reporting....more

3/16/2022 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Insurance , OIG

August Fast Break Recap – CMS Telehealth and RPM Updates

We hosted a very informative Fast Break session last month on CMS telehealth and RPM updates. If you weren't able to join us, the session was led by healthcare litigation associates Jake Harper and Tesch West, with special...more

9/10/2021 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Rules , Telehealth , Telemedicine

Tesch Leigh West

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