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Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
McDermott Will & Schulte

This Week in 340B: June 24 – 30, 2025

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Find this week’s updates on 340B litigation to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets of more than 50 340B cases to provide you with a quick...more

Troutman Pepper Locke

U.S. Supreme Court Holds Medicaid’s Any-Qualified-Provider Provision Does Not Confer Enforceable Rights

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The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more

Stotler Hayes Group, LLC

Common Medicaid Application Mistakes: Errors to Avoid During the Application Process

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The Medicaid application process can be complicated. However, there are several common mistakes made by filers that can make things even more difficult than they need to be, adding unnecessary obstacles. In this article, we...more

Troutman Pepper Locke

Federal Ruling on CMS Staffing Mandate Offers Relief for Long-Term Care Facilities

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Long-term care facilities, embattled by rising costs and potential Medicaid cuts, are seeing some relief on the horizon following a recent federal court ruling that struck down portions of the Centers for Medicare & Medicaid...more

Sheppard Mullin Richter & Hampton LLP

Recent Legal and Regulatory Developments Involving Gender-Affirming Care

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On January 28, 2025, President Trump signed Executive Order 14187 (the “EO”), which directed the federal government to take steps to ensure that the federal government does not “sponsor, promote, assist, or support” the...more

Perkins Coie

First Circuit Imposes Higher “But-for” Causation Standard for False Claims Act Liability Based on Alleged Anti-Kickback Statute...

Perkins Coie on

On February 18, 2025, the U.S. Court of Appeals for the First Circuit added its voice to a growing chorus of appellate courts to elevate the standard of proof required to show a violation of the federal False Claims Act in...more

Hanson Bridgett

Federal Judge Vacates Key Provisions of CMS’s Nursing Home Staffing Mandate

Hanson Bridgett on

Earlier last week, Hon. Matthew J. Kacsmaryk of the U.S. District Court for the Northern District of Texas vacated two key provisions of CMS’s 2024 nationwide staffing mandate, the requirements that skilled nursing facilities...more

Littler

New York Court Issues Decision and Order Declaring the DOH’s August 2024 Reimbursement Rate Adjustment for Fiscal Intermediaries...

Littler on

On March 20, 2025, a New York Supreme Court Justice in Albany County issued a decision and order declaring the New York State Department of Health (NY DOH)’s August 2024 implementation of an administrative rate reimbursement...more

Arnall Golden Gregory LLP

Insights From the 2025 American Health Law Association’s Long Term and Post-Acute Care Law and Compliance Conference

Arnall Golden Gregory LLP on

This year, health lawyers, providers, consultants, and government experts from across the country convened in Orlando, Florida, for the American Health Law Association’s Long Term and Post-Acute Care Law and Compliance...more

ArentFox Schiff

Investigations Newsletter: Supreme Court Again Tightens FCA Intent, But Tricky Questions Linger

ArentFox Schiff on

The US Supreme Court brushed aside novel assertions from two pharmacy retailers on June 1 and ruled unanimously that False Claims Act liability hinges on whether defendants subjectively believed their claims were “false.” In...more

Foley Hoag LLP - Security, Privacy and the...

Fifth Circuit Addresses Scope of “Use” Under Federal Identity Theft Statute

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You may have forgotten that there is a federal criminal identity theft statute, 18 U.S.C. § 1028A, which says: Whoever, during and in relation to any felony violation enumerated in subsection (c), knowingly transfers,...more

Holland & Knight LLP

Healthcare Law Update: December 2016

Holland & Knight LLP on

Prompt Payment Discounts Not an Anti-Kickback Statute Violation - In United States of Am. et al. ex rel. Ruscher v. Omnicare, No. 15-20629, 2016 WL 6407128 (5th Cir. Oct. 28, 2016), the court of appeals affirmed summary...more

Adams and Reese LLP

Government Latin Lessons

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A couple of years ago, we discussed in an article in this publication the willingness of Centers for Medicare & Medicaid (“CMS”)and the United States Attorneys’ Office to pursue actions for violations of the False Claims Act...more

McGuireWoods LLP

Washington Healthcare Update

McGuireWoods LLP on

This Week: House Ways & Means Committee Holds Markup; Makes Significant Legislative Changes to Health Care Bills... Senate Finance Committee Holds Markup on Medicare Appeals Process Bill... CMS Issues Final Rule on...more

Faegre Drinker Biddle & Reath LLP

New CMS Ruling on DSH Appeals for FY 2004 and Earlier

Faegre Drinker Biddle & Reath LLP on

It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued...more

Epstein Becker & Green

Supreme Court Rules That Providers and Suppliers Cannot Challenge Medicaid Reimbursement Rates in Federal Court

Epstein Becker & Green on

On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more

Pullman & Comley, LLC

Appellate Court Notes

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SC18928 - Rathbun v. Health Net of the Northeast, Inc. - In Connecticut, the Department of Social Services manages the federal Medicaid act and awards contracts to Medicaid managed health care providers. The defendant...more

King & Spalding

Provider Reimbursement Review Board Issues 60 Day Deadline to Supplement Record in All DSH Medicaid Eligible Days Appeals

King & Spalding on

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers of an important new 60 day deadline concerning certain appeals before the Provider Reimbursement Review Board (PRRB or Board). By the end of...more

Proskauer - Government Contractor Compliance...

Second Circuit Dismisses $50 Million FCA Suit

Proskauer - Government Contractor Compliance... on

Last week, the United States Court of Appeals for the Second Circuit affirmed the dismissal of a False Claims Act (“FCA”) whistleblower suit seeking $50 million in damages from Huron Consulting Group Inc. (“Huron”) for...more

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