In a recently issued opinion, the Fifth Circuit has added yet another chapter to the growing debate over whether providers may seek judicial enforcement of Independent Dispute Resolution (“IDR”) awards issued under the No...more
6/30/2025
/ Appeals ,
Arbitration Awards ,
Department of Health and Human Services (HHS) ,
Dispute Resolution ,
Federal Arbitration Act ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
Insurance Litigation ,
Judicial Review ,
No Surprises Act (NSA) ,
Statutory Interpretation
The Department of Justice’s (“DOJ”) May 19, 2025 “Civil Rights Fraud Initiative” memorandum, issued by Deputy Attorney General Todd Blanche (the “Initiative”), marks a consequential policy shift for False Claims Act (“FCA”)...more
The U.S. Supreme Court has issued a significant ruling affecting hospitals that serve low-income Medicare beneficiaries, narrowing the interpretation of the Disproportionate Share Hospital (“DSH”) payment formula. In...more
5/23/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Government Agencies ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Medicaid ,
Medicare ,
Reimbursements ,
SCOTUS ,
Statutory Interpretation ,
Supplemental Security Income (SSI)
On March 3, 2025, the United States Department of Health and Human Services (“HHS”) issued a policy statement rescinding the Richardson Waiver, a policy in place since 1971 that required notice-and-comment rulemaking for...more
On December 11, 2024, the Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) issued a special fraud alert warning about certain marketing schemes that involve questionable payments and...more
12/18/2024
/ Anti-Kickback Statute ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud Alerts ,
Health Care Providers ,
Marketing ,
Medicare Advantage ,
OIG ,
Telemedicine ,
Third-Party
This week, the U.S. Attorney’s Office for the District of Colorado (“USAO”) announced that it entered into a series of interrelated settlement agreements with companies that provide intraoperative neuromonitoring (“IONM”)...more
The Fifth Circuit Court of Appeals has handed down a significant decision in response to a challenge from health care providers to the implementing regulations of the No Surprises Act (“NSA”). The Court upheld the...more
In a victory for Texas health care providers, in Baylor All Saints Medical Center dba Baylor Scott & White All Saints Medical Center‑Fort Worth et al. v. Xavier Becerra, case number 4:24‑cv‑00432, the United States District...more
9/11/2024
/ Administrative Procedure Act ,
Chevron Deference ,
Declaratory Relief ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
Exclusions ,
Federal Trade Commission (FTC) ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Loper Bright Enterprises v Raimondo ,
Medicaid ,
No Surprises Act (NSA) ,
Permanent Injunctions ,
Provider Reimbursement Review Board ,
Texas
In a recent win for health care providers, the United States Court of Appeals for the Fifth Circuit has affirmed a lower court’s decision to vacate key portions of regulations issued by the U.S. Departments of Treasury,...more
8/16/2024
/ Administrative Procedure Act ,
Appeals ,
Appellate Courts ,
Chevron Deference ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Health Care Providers ,
Loper Bright Enterprises v Raimondo ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Payment Systems ,
Regulatory Standards ,
SCOTUS ,
U.S. Treasury ,
Vacated
In recent years, a circuit split among the United States Courts of Appeals has emerged over how courts have interpreted the False Claims Act’s (“FCA”) causation element in cases where a violation of the Anti-Kickback Statute...more
5/29/2024
/ Anti-Kickback Statute ,
Appeals ,
But For Causation ,
Causation ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Kickbacks ,
OIG ,
Patient Assistance Programs ,
Proximate Cause ,
Regeneron ,
Regulatory Requirements ,
Reimbursements