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
n a July 2, 2025, press release, the U.S. Department of Justice (DOJ) announced a new “DOJ-HHS False Claims Act Working Group” (the Working Group) and identified multiple priority enforcement efforts for the Working Group to...more
As discussed in last week’s Regs & Eggs blog post, the US Department of Health and Human Services (HHS) recently released additional budget documents to support the department’s fiscal year (FY) 2026 discretionary request....more
It’s getting hot outside, which means that the summer regulatory season is almost upon us. In June or July, the Centers for Medicare & Medicaid Services (CMS) will release proposed regs impacting Medicare payments in...more
Last week, the Supreme Court issued its opinion in Advocate Christ Medical Center v. Kennedy, siding with the government and holding that, for purposes of the Medicare disproportionate share hospital (DSH) calculation,...more
On April 11, 2025, the Centers for Medicare & Medicaid Services (“CMS”) published its annual proposed rule for the federal fiscal year (“FFY”) 2026 inpatient prospective payment system (“IPPS”) and long-term care hospital...more
Within its proposed CY 2025 Physician Fee Schedule (PFS) rule (the Proposed Rule), CMS is proposing to implement new payment policies intended to advance health equity and support whole-person care. CMS expects these new...more
The upcoming election, and the approaching end of the President’s four-year term, introduce additional dynamics into the agencies’ rulemaking process and even the guidance process. From now through the November election, the...more
House Energy & Commerce Health Subcommittee Holds Hearing on Cybersecurity. During the hearing, there was bipartisan concern about UnitedHealth Group’s response to the Change Healthcare cyberattack and consensus around the...more
Senate HELP Committee Holds Field Hearing on Private Equity. In the hearing, held at the Massachusetts State House, members discussed the impact of private equity ownership on patients, providers, quality of care and...more
Last Sunday, Congress released the text of a minibus package, which will likely be signed into law by tomorrow. While the bill’s primary purpose is to keep the government open, it also includes healthcare extenders through...more
In this session, McDermott Will & Emery partner Matthew Perreault moderated a panel that discussed the current state of value-based care in original Medicare and lessons learned from the panelists’ experiences with various...more
Introduction: Defining Interprofessional Consultation - In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance...more
On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more
We have noted before the link between the Medicaid prescription drug rebate program and the 340B program. As we wrote in an earlier Client Alert, in June 2022, the U.S. Supreme Court struck down HHS’s Medicare payment cuts to...more
Enrolling in such a CMS-sponsored innovation model now has an added benefit: a new Anti-Kickback Statute (AKS) safe harbor. ...In its mission to reward value over volume, the Centers for Medicare & Medicaid Services’ (CMS)...more
On December 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2021 Final Rule implementing changes to the Medicare hospital Outpatient Prospective Payment System (OPPS) and Ambulatory...more
Earlier this month, the U.S. Department of Health and Human Services Office of the Inspector General (the “OIG”) released a report highlighting concerns about the extent to which Medicare Advantage Organizations (“MAOs”) are...more
On August 11, 2020, the CMS Innovation Center, the office within HHS with authority to create and test healthcare payment systems, announced a new payment model – the Community Health Access and Rural Transformation (CHART)...more
On August 11, the Center for Medicare & Medicaid Services ("CMS") announced the creation of its new Community Health Access and Rural Transformation (“CHART”) Model. The CHART Model seeks to provide new seed funding and...more
On June 3, 2020, CMS announced changes to the Center for Medicare and Medicaid Innovation (CMMI) value-based care payment models. Notably, the changes include delaying the start date for new models that would test government...more
On August 17, 2018, the Centers for Medicare and Medicaid Services (CMS) issued the FY 2019 Medicare IPPS final rule. Part of the rule modified the supporting documentation required under 42 CFR 413.20 to be submitted with...more
On August 2, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital Prospective Payment System...more
Medicare is proposing a new flat rate reimbursement system for doctors who treat Medicare patients. Some worry that the plan may reduce payments to specialists and cause fewer doctors to accept Medicare patients....more
Market Based Payment for Clinical Diagnostic Laboratory Tests - Summary - On June 17, 2016 the Centers of Medicare & Medicaid Services (CMS) issued the long awaited Medicare Clinical Diagnostic Laboratory Tests...more
CMS Issues SNF Final Payment Rule for FY 2016 – On July 30, 2015, CMS released the final Medicare FY 2016 payment rule for skilled nursing facilities (SNFs). The final rule will result in an estimated increase of $430 million...more