News & Analysis as of

Enforcement Actions Patient Protection and Affordable Care Act (PPACA)

Foley & Lardner LLP

CMS Finalizes Rule Change Applying Preponderance of the Evidence Standard to Agent, Broker, and Web-Broker Exchange Agreement...

Foley & Lardner LLP on

In its recently issued Final Rule (CMS-9884-F; 90 FR 27074-01; the Final Rule), the Centers for Medicare and Medicaid Services (CMS) finalized revisions to 45 C.F.R. § 155.220(g)(2) to specify a standard of proof for...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | June 2025 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for June 2025, including a new Centers for Medicare & Medicaid Services (CMS) innovation model; proposed rules with significant...more

Foley & Lardner LLP

Gender-Affirming Care: What the Supreme Court’s Ruling in Skrmetti Means for Health Care Providers Nationwide

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On June 18, 2025, the U.S. Supreme Court delivered a major decision in United States v. Skrmetti, allowing Tennessee’s ban on gender-affirming care for minors to take effect. The ruling reflects a substantial realignment in...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | April 2025 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for April 2025, including Centers for Medicare & Medicaid Services (CMS) updates to Medicare Advantage (MA) and other Medicare programs....more

Amundsen Davis LLC

Court Ruling Hamstrings IRS Enforcement of ACA Employer Mandate

Amundsen Davis LLC on

On April 10, 2025, a federal court in Texas issued an opinion in the case of Faulk Co. v. Becerra that significantly impacts how the Affordable Care Act’s (ACA) employer mandate can be enforced. The ruling effectively...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | March 2025 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights key regulatory and enforcement activity for March 2025. This month features: - Noteworthy enforcement actions demonstrating that the Anti-Kickback Statute...more

Cozen O'Connor

The State AG Report – 04.17.2025

Cozen O'Connor on

Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •Illegal E-Cigarette Sales Targeted by AG Enforcement...more

Bricker Graydon LLP

What Goes Around Comes Around: White House Signals Increased Transparency in Coverage Enforcement

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On February 25, 2025, the White House issued a new executive order aimed at implementing many of the Administration's previously issued directives to health plans. ...more

Davis Wright Tremaine LLP

Stay ADvised: 2025, Issue 3

FTC's Final Junk Fees Rule Narrowed in Scope - On December 17, 2024, the Federal Trade Commission (FTC) released its final Rule on Unfair or Deceptive Fees, commonly known as the "Junk Fees Rule." This final rule has a...more

Genova Burns LLC

10th Birthday Wishes to the Affordable Care Act’s Employer Mandate

Genova Burns LLC on

The Patient Protection and Affordable Care Act (“ACA”) was signed into law by President Obama on March 23, 2010. ACA affected health insurance coverage, costs and preventive care. It also established the Health Insurance...more

Mintz - Health Care Viewpoints

HHS Court Filings Indicate that Agency Intends to Preserve Copay Accumulators

As we wrote about in our prior blog post, on September 29, 2023, John D. Bates of the U.S. District Court for the District of Columbia struck down a federal rule that permitted health plans and pharmacy benefit managers...more

McDermott Will & Schulte

New Illinois Protections Against Patient Medical Debt May Also Help Reduce Hospital Bad Debt

Starting in mid-2024, Illinois hospitals will be required to take a much more active role in limiting consumers’ medical debt by screening all consenting uninsured patients for both public health insurance program coverage...more

Polsinelli

Department of Labor Sues UnitedHealth TPA Over Claim Denials

Polsinelli on

The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more

McDermott Will & Schulte

The ‘No More Restrictive’ Requirement for NQTLs Under the Proposed MHPAEA Regulations

We previously reported on proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). If adopted in final form, these regulations would vastly complicate compliance by group health plans and health...more

Orrick, Herrington & Sutcliffe LLP

Antitrust Enforcement in Health Care: Increased Scrutiny Likely After DOJ Withdraws Policy Statements

The Department of Justice (DOJ) recently withdrew three longstanding health care focused antitrust enforcement policy statements that had provided certain “safety zones” for mergers, joint ventures, group purchasing, and...more

Foley & Lardner LLP

DOJ Antitrust Division and HHS OIG Enter into Partnership to Increase Coordination and Enforcement in Health Care

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On December 9, 2022, the U.S. Department of Justice Antitrust Division (DOJ) and Office of Inspector General of the U.S. Department of Health and Human Services (OIG) announced they had entered a Memorandum of Understanding...more

Verrill

Agencies Heed President’s Call to Take Action to Protect Access to Sexual and Reproductive Health Care Post-Dobbs

Verrill on

Within days of the Supreme Court’s June 24th Dobbs decision, which held that the Constitution does not guarantee the right to an abortion, key government agencies have taken action to protect access to sexual and reproductive...more

King & Spalding

HHS Proposes Repeal of Two Trump Administration Rules on Guidance, Enforcement, and Adjudication Procedures

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On October 20, 2021, HHS published in the Federal Register a proposal to repeal two final rules issued during the Trump administration. The final rules up for repeal are the “Department of Health and Human Services Good...more

Health Care Compliance Association (HCCA)

[Virtual Event] Louisville Regional Healthcare Compliance Conference - October 29th, 8:25 am - 4:30 pm EDT

Our Virtual Regional Healthcare Compliance Conferences provide updates on the latest news in regulatory requirement, compliance enforcement, and strategies to develop effective compliance programs. Watch, listen, and ask...more

Sheppard Mullin Richter & Hampton LLP

Federal Government Announces Enforcement Discretion, Deferral For Certain Price Disclosures And Future Rulemakings

Health plans and issuers racing to implement overlapping price transparency and disclosure requirements in response to the Transparency in Coverage final rule (TiC Final Rule) and the Consolidated Appropriations Act, 2021...more

Bricker Graydon LLP

Skilled nursing facility operator settles false claims case involving allegations that the company failed to report and return...

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On June 29, 2021, the Department of Justice (DOJ) announced a settlement with California skilled nursing facility operator Plum Healthcare Group LLC and facility Azalea Holdings LLC dba McKinley Park Care Center (Plum) to...more

Foley & Lardner LLP

Latest Open Payments Data Released Under Heightened Government Scrutiny

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On June 30, 2021, the Centers for Medicare & Medicaid (CMS) released Open Payments data for the past year, 2020. This new data publication comes amid heightened government scrutiny of payments by drug and medical device...more

The Volkov Law Group

Bioventus Agrees to Pay $3.6 Million to Settle False Claims Act Violations

The Volkov Law Group on

The False Claims Act is a powerful tool for government prosecutors to use against healthcare providers, and drug and device companies.  The Trump Administration used the False Claims Act to attack the opioid industry and rein...more

Rivkin Radler LLP

Medtronic Settles Kickback And Open Payments Violations For $9.2M

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The U.S. Department of Justice (DOJ) announced on October 29 that Medtronic USA Inc. agreed to pay $8.1 million to settle allegations that it violated the False Claims Act (FCA) and federal Anti-Kickback Statute by paying...more

Morgan Lewis - ML Benefits

DOL’s ERISA Enforcement Activities Focus on Health Plan Compliance

In recent years, reports have indicated robust, and in some respects increasing, enforcement activities by the US Department of Labor (DOL) related to ERISA. The DOL recently issued its enforcement statistics for fiscal year...more

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