1+ week, 9+ hour ago  (352+ words) The US Department of Health and Human Services Office of Inspector General (OIG) recently issued Advisory Opinion No. 26-02, concluding that a proposed arrangement under which an urgent care management entity would operate an affiliated clinical laboratory would not generate prohibited…...

1+ week, 1+ day ago  (627+ words) Key Takeaways - DOJ's $556 million settlement with Kaiser Permanente shows intensified False Claims Act enforcement in Medicare Advantage risk-adjustment coding. Federal regulators continue to prioritize alleged upcoding and unsupported diagnosis submissions under Medicare Part C....By: Arnall Golden Gregory LLP Kaiser's $556 Million…...

1+ week, 1+ day ago  (1500+ words) On February 11, 2026, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), published the proposed Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program (2027 Payment…...

1+ week, 2+ day ago  (393+ words) The Centers for Medicare & Medicaid Services ("CMS") unveiled the Long-term Enhanced Accountable Care Organization ("ACO") Design ("LEAD") model, which aims to expand provider participation, increase beneficiary involvement in preventive care, and modernize financial benchmarking for long-term stability....By: Jones Day…...

1+ week, 3+ day ago  (729+ words) All hospitals operating off-campus outpatient provider-based departments (HOD) must be aware of and prepare for upcoming new requirements imposed by Section 6225 of the Consolidated Appropriations Act of 2026 (CAA). Specifically, under the CCA, as of January 1, 2028, Medicare will no longer make…...

1+ week, 4+ day ago  (520+ words) The MA ICPG is only the second ICPG to be issued since OIG announced its "Modernization of Compliance Program Guidance Documents" initiative in April 2023. Its release underscores that managed care oversight is a top priority of OIG, as Medicare and…...

1+ week, 4+ day ago  (171+ words) The ICPG addresses several risk areas central to the MA industry, noting that OIG's discussion of a particular practice or activity "is not intended to imply that the practice or activity is necessarily illegal[.]" Additionally, OIG notes that strategies to…...

1+ week, 6+ day ago  (624+ words) Our Health Care Team outlines the HHS Office of Inspector General's first update to its Medicare Advantage compliance guidance since 1999 and the key risk areas that Medicare Advantage organizations and their partners should address. In February 2026, the U.S. Department of Health…...

2+ week, 7+ hour ago  (935+ words) In this alert, we summarize key details of the Office of Inspector General's (OIG) updated Medicare Advantage Compliance Program Guidance (the "Guidance) for Medicare Advantage Organizations (MAOs), delegated providers, and first-tier, downstream, and related entities (FDRs). The new guidance reflects…...

2+ week, 10+ hour ago  (286+ words) On February 9, 2026, CMS, issued its proposed "Notice of Benefit and Payment Parameters" for the 2027 plan year (the "2027 Proposed Rule"). This annual rulemaking introduces updates to the implementation of the Patient Protection and Affordable Care Act ("ACA") and sets forth standards…...