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Government Agencies Department of Justice (DOJ) Centers for Medicare & Medicaid Services (CMS)

Ropes & Gray LLP

Hospital and Health Systems Reimbursement Check July 2025

Ropes & Gray LLP on

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

ArentFox Schiff

Investigation Newsletter: DOJ and HHS Emphasize Continued, Robust, and Coordinated Health Care Enforcement with Revival of False...

ArentFox Schiff on

The government has announced a renewed and expanded focus on False Claims Act (FCA) enforcement, doubling down on traditional health care priorities like kickbacks and drug pricing while signaling increased scrutiny of...more

Bass, Berry & Sims PLC

Wound Care in the Crosshairs: Reimbursements Risks Amid Skin Substitute Fraud Investigations

Bass, Berry & Sims PLC on

Effective wound care is critical for patients recovering from surgery or managing chronic or non-healing wounds. Advances in treatment have led to the development of skin substitutes—bioengineered or natural materials...more

Ropes & Gray LLP

CMS Announces Significant Changes to RADV Auditing Efforts: Considerations and Next Steps for the Medicare Advantage Industry

Ropes & Gray LLP on

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced plans to substantially increase both the pace and the scale of Risk Adjustment Data Validation (“RADV”) audits of the Medicare Advantage (“MA”)...more

Holland & Knight LLP

Holland & Knight Health Dose: May 6, 2025

Holland & Knight LLP on

Reconciliation markups in the U.S. House of Representatives Committee on Energy and Commerce, as well as the House Committee on Ways and Means, were expected to be held this week but have been postponed until next week at the...more

Morgan Lewis

Risk Adjustment Continues to be A Major Focus in Medicare Advantage

Morgan Lewis on

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from enforcement and...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

The Medicare Advantage Program: Public Money & Private Insurance Companies

When I investigated and litigated False Claims Act (FCA) cases at the U.S. Department of Justice (DOJ) over the last 10 years, I was often surprised by just how little I knew about the broad array of government agencies and...more

Holland & Knight LLP

What's Next for the Regulatory Landscape Post-Chevron?

Holland & Knight LLP on

For nearly 40 years and in more than 18,000 judicial opinions, federal courts have used the Chevron doctrine to defer to an agency's reasonable interpretation of an ambiguous statute. On June 28, 2024, the U.S. Supreme Court...more

Bradley Arant Boult Cummings LLP

Second Circuit Limits Use of Confidential Government Agency Information as Basis for Securities Fraud Prosecutions

On December 27, 2022, the Second Circuit called into question the government’s theory of insider trading of confidential government agency information, potentially undercutting the DOJ’s enforcement of various white-collar...more

Akin Gump Strauss Hauer & Feld LLP

Under What Circumstances Can a Private Qui Tam Plaintiff Overrule Government Agency Experts' Use of Administrative Discretion to...

• How have appellate courts applied the Supreme Court’s ruling in Escobar? • If the government is aware of the relator’s allegation, but does not undertake any administrative action to address the defendant’s alleged...more

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