The State of Healthcare Enforcement
Hospice Insights Podcast - Election Inspection: Be Proactive to Avoid Costly Election Statement Denials
Medicaid Cuts: Potential Challenges and Legal Implications for Long-Term Care Facilities — Assisted Living and the Law Podcast
False Claims Act Insights - How Payment Suspensions Can Impact FCA Litigation
Federal Court Strikes Down FDA Rule on LDTs - Thought Leaders in Health Law®
UPIC Audits
AGG Talks: Home Health & Hospice Podcast - Episode 8: Hospice Special Focus Program: Pumping the Brakes
Hospice Insights Podcast - Upping the Ante: Will CMS’s Enhanced Oversight Efforts Cause Hospices to Fold?
Podcast — Drug Pricing: What’s in the New CMS Medicaid Final Rule?
Hospice Insights Podcast - What a Difference No Deference Makes: Courts No Longer Bow to Administrative Agencies
Preparing for CMS Staffing Mandates — Assisted Living and the Law Podcast
Hospice Insights Podcast - Meet the New Laws, Same as the Old Laws: Overpayment Recoupment Update
Podcast — Drug Pricing: Takeaways From the Chicago Medicaid Drug Rebate Program Summit
Podcast — Drug Pricing: How the Demise of Chevron Deference and Other Litigation May Impact the Pharmaceutical Industry
The CMS Interoperability and Prior Authorization Rules
Podcast — Drug Pricing: How Are Payers Responding to the IRA?
Findings from Gibbins’ Annual Healthcare Bankruptcy Report
A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration
Video: Braidwood v. Becerra – Challenging the Affordable Care Act’s Preventive Services Coverage Provision – Thought Leaders in Health Law
On August 21, 2025, HHS OIG published a Data Brief, Report No. A-04-24-03003, which analyzed the frequency and outcomes for Medicare enrollees who chose to leave acute-care hospitals against medical advice (“AMA”). OIG found...more
In a recent Aetna newsletter update (also referred to as OfficeLink), Aetna advised that it would change its reimbursement approach for emergent or urgent inpatient stays that span at least one midnight at facilities that...more
News Briefs - Physician Productivity Rising, But Reimbursement Isn't -Physicians are working more than ever, but reimbursement isn't rising in tandem. It's a worrying mismatch that could translate into access problems for...more
On August 1, 2025, CMS issued a final rule updating the Medicare rates and policies applicable to inpatient rehabilitation facilities (IRFs) under the IRF Prospective Payment System (PPS) and the IRF Quality Reporting Program...more
An investigation highlighted concerns about for-profit dialysis clinics in the U.S., which are linked to worse patient outcomes and reduced transplant access. DaVita and Fresenius, controlling over 60% of dialysis centers,...more
On August 4, 2025, CMS issued a final rule (Final Rule) updating payment rates, policies, and quality programs for Skilled Nursing Facilities (SNFs) under the Medicare Prospective Payment System (SNF PPS) for Fiscal Year (FY)...more
The ongoing case Jhumra v. Orange County Global Medical Center (OCGMC) stems from an alleged delay in care and serves as a stark reminder of the legal obligations for hospitals and medical staffs under the Emergency Medical...more
In the early days of the second Trump Administration, several federal funding agencies announced caps to indirect cost (“IDC”) rates for federally funded research awards. In many cases, these caps would substantially reduce...more
The Centers for Medicare & Medicaid Services (“CMS”) has extended the window for skilled nursing facilities (“SNFs”) to file off-cycle Medicare revalidation documents until January 1, 2026. This marks CMS’ third deadline...more
On July 4, President Donald Trump signed into law H.R. 1, commonly known as the “One Big Beautiful Bill,” or OBBB. The bill is a sweeping package that includes an estimated $1 trillion in cuts to Medicaid. These cuts include...more
Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more
CMS Releases Proposed Rule for 2026 ESRD PPS - As the nephrology organization representing the specialty on socioeconomic and physician practice issues, the Renal Physicians Association analyzes and disseminates...more
The Centers for Medicare & Medicaid Services (CMS) on July 14, 2025, issued the calendar year (CY) 2026 Proposed Rule, which proposes payment policies and other outpatient services covered under Medicare Part B. Comments are...more
On June 16, 2025, the U.S. Senate Finance Committee released draft legislative language for its version of the “One Big Beautiful Bill Act,” a comprehensive budget reconciliation proposal that includes significant changes to...more
A federal judge in Iowa recently struck down key parts of a Biden-era final rule that set new minimum staffing standards for long-term care facilities as a condition of participation in Medicare or Medicaid programs. The June...more
News Briefs - Federal Judge Rejects Nursing Home RN Staffing Mandate - A federal judge has struck down the federal nursing home staffing mandate's demands that a registered nurse be on duty 24/7 every day of the year, as well...more
On May 28, 2025, the Centers for Medicare & Medicaid Services (“CMS”) Innovation Center formally announced the early termination of the Kidney Care First (“KCF”) model effective December 31, 2025, and issued a suite of...more
What is the cost of a knee implant in the inpatient setting? How much does Medicare pay for different types of cardiac valve procedures? How have Medicare inpatient volumes changed over time for inpatient hip and femur...more
On June 18, Centers for Medicare and Medicaid Services published new guidance announcing a major change to the way Care Compare will display survey information and the methodology for calculating the health inspection score...more
Updated to include Medicare claims data thru Q4 2024. What is the cost of a knee implant in the inpatient setting? How much does Medicare pay for different types of cardiac valve procedures? How have Medicare inpatient...more
Even as long-term care providers celebrate a proposed 10-year moratorium on the nursing home staffing mandate[1], they are sounding the alarm over major Medicaid cuts included in the House-passed budget reconciliation bill...more
The Centers for Medicare & Medicaid Services (CMS) recently published a press release rescinding its June 2022 guidance concerning hospitals’ obligations to pregnant women under the Emergency Medical Treatment & Labor Act...more
CMS announced in a letter released on Tuesday, May 27, 2025 (CMS Letter) that it will ramp up financial oversight of states to detect misuse of federal Medicaid funds “[t]o ensure that federal money is not used to pay for or...more
The Centers for Medicare & Medicaid Services (CMS) released new Updated Hospital Price Transparency Guidance (Guidance) to “strengthen the Hospital Price Transparency requirements, requiring hospitals to post the actual...more
Two Pennsylvania nursing home operators were recently sentenced in federal court to pay more than $15 million in restitution in a healthcare fraud case. Comprehensive Healthcare Management Services, the operator of Brighton...more