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Davis Wright Tremaine LLP

CMS Launches WISeR Model to Curb Overuse of Medicare Services

The Centers for Medicare and Medicaid Services (CMS) is looking to reduce the volume of "low value" services furnished to Original Medicare beneficiaries through the recently announced Wasteful and Inappropriate Service...more

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Phelps Dunbar

Medicare’s New AI Payment Review Model: What Providers Need to Know

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CMS announced the rollout of the WISeR (Wasteful and Inappropriate Service Reduction) model in June. It aims to use technologies like artificial intelligence (AI) to “ensure timely and appropriate Medicare payment for select...more

McDermott+

September 2025 CPT Editorial Panel meeting: what’s on the agenda and why it matters

McDermott+ on

The American Medical Association (AMA) CPT®* Editorial Panel will convene in Chicago, Illinois, from September 18 to 20, 2025. The meeting agenda includes proposals to create new current procedural terminology (CPT) codes and...more

Alston & Bird

Getting the Band Back Together: DOJ and HHS Launch New False Claims Act Enforcement Working Group

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The Department of Health and Human Services and the Department of Justice have formed a False Claims Act (FCA) enforcement working group to target health care fraud. Our Health Care Litigation Group highlights what industry...more

Tucker Arensberg, P.C.

New CMS Model Targets Inefficient Medicare Spending Through AI and Clinical Oversight

The Centers for Medicare & Medicaid Services (CMS) has launched the WISeR Model (Wasteful and Inappropriate Service Reduction) to modernize and streamline Medicare’s prior authorization process. ...more

Benesch

CMS Launches WISeR Model: A Technology-Enabled Effort to Reduce Wasteful Medicare Spending

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On June 27, 2025, the Centers for Medicare & Medicaid Services (“CMS”), through its Innovation Center (“CMMI”), released the Request for Applications (“RFA”) for a new payment and service delivery initiative: the Wasteful and...more

Benesch

Dialysis & Nephrology Digest - June 2025

Benesch on

Byonyks, a medical device company focused on advancing dialysis care, today announced that it has received U.S. Food and Drug Administration (FDA) 510(k) clearance for the Byonyks X1 APD Cycler, an automated peritoneal...more

Jones Day

Medicare's Innovation Center Charts New Direction: Part 2 – Digital Health and AI

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The Center for Medicare and Medicaid Innovation ("CMMI") is set to reshape value-based care. In the second of a three-part series highlighting this new direction, this summary is focused on CMMI's efforts regarding digital...more

Holland & Knight LLP

Holland & Knight Health Dose: May 13, 2025

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U.S. House of Representatives committees are scheduled to begin markups on additional portions of the budget reconciliation package on May 13, 2025. Both the House Committee on Ways and Means and the House Committee on Energy...more

Holland & Knight LLP

Holland & Knight Health Dose: April 8, 2025

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Looking Ahead: House to Vote on Compromise Budget Resolution On the heels of the U.S. Senate's passage of a compromise budget resolution, the U.S. House of Representatives is expected to consider the budget resolution on the...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - March 2025 #3

News Briefs - Congress Extends Telehealth Flexibilities for Another Six Months - Pandemic-related telehealth flexibilities set to expire March 31 have recently been extended for another six months as federal lawmakers approve...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - March 2025 #1

News Briefs - Trump Signs Executive Order to Improve Health Price Transparency - U.S. President Donald Trump signed an executive order aiming to improve price transparency on healthcare costs by directing federal agencies to...more

Arnall Golden Gregory LLP

UnitedHealthcare Must Face State Law Claims in Class Action Suit for AI Driven Coverage Denials of Medicare Advantage Claims

Daytime television inundates American seniors with advertisements for UnitedHealthcare’s (“UHC”) Medicare Advantage Plans. On its website, UHC claims its Medicare Advantage Plans “stand out from the rest,” providing...more

McDermott+

McDermott+ Check-Up: February 28, 2025

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House Passes Budget Resolution. On February 25, the House voted 217 – 215 to advance its version of a budget resolution to outline the reconciliation process. In a dramatic display of how quickly things can change, the vote...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - February 2025 #3

News Briefs - Proposed Budget Cuts Could Greatly Impact Healthcare Sector - House Republicans unveiled a budget resolution that asks the Energy and Commerce Committee, which oversees Medicare and Medicaid, to find $880...more

Holland & Knight LLP

Holland & Knight Health Dose: February 19, 2025

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector....more

Sheppard Mullin Richter & Hampton LLP

Healthcare Industry Leaders Predict Four Areas to Watch After the U.S. Election: Takeaways from the Business of Health Care...

The recent U.S. election has had profound implications for the healthcare industry, prompting industry leaders to reexamine their strategies and day-to-day operations. At the Miami Herbert Business School’s annual “The...more

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

Fennemore on

In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more

BakerHostetler

Healthcare Industry Team 2024 Year in Review

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As we begin a year that will once again be transformative for the industry, we are excited to present our comprehensive 2024 year-in-review, highlighting all that has happened and the trends that will shape 2025. ...more

Spilman Thomas & Battle, PLLC

The Health Record - Healthcare Law Insights, V 2, Issue 1, January 2025

Welcome to our second volume and first issue of 2025 of The Health Record - our healthcare law insights e-newsletter. We hope you enjoyed our Volume 1 issues in 2024 and look forward to continuing to provide information about...more

Troutman Pepper Locke

Q4 2024 Health Care Conference Roundup: AI and Government Enforcement Are on the Rise

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Last quarter, our attorneys had the privilege of attending three prominent health care conferences, each of which offered a wealth of knowledge and insights into the current and future landscape of the health care industry. ...more

McCarter & English Blog: Government Contracts...

Antitrust Corporate Compliance Programs: Late 2024 Changes Mean Companies Should Revisit Their Programs Early in 2025

The US Department of Justice Antitrust Division (DOJ or Division) recently released a revised Evaluation of Corporate Compliance Programs in Criminal Antitrust Investigations (Guidance). The Guidance reflects how the Division...more

Akin Gump Strauss Hauer & Feld LLP

A New Year, Congress and Trump Administration: 10 Health Issues to Watch in 2025

As the new year begins, change is afoot inside the Beltway as the 119th Congress gets underway and Washington prepares for President Trump’s second administration. While change is bringing uncertainty on some fronts, health...more

Mintz - Health Care Viewpoints

California Health Care Legislative Update: Winter 2024

Governor Newsom signed over 1300 bills and vetoed almost 190 bills in 2024. Consistent with prior years, in 2024, California enacted multiple laws significantly impacting the health care industry. From artificial intelligence...more

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