News
Medicare Advantage- New OIG Compliance Guidance Has Implications for Providers
7+ hour, 44+ min ago (268+ words) The Medicare Advantage ICPG is meant to identify risk areas for those engaging with or participating in Medicare Advantage, provide recommendations and practical considerations for mitigating those risk areas, and highlight other important information that the OIG believes parties should…...
No Surprises Here! Air Ambulance Providers Petition Supreme Court to Review Fifth Circuit’s No Surprises Act and ERISA Standing Decision
1+ mon, 1+ week ago (683+ words) No Surprises Here! Air Ambulance Providers Petition Supreme Court to Review Fifth Circuit's No Surprises Act and ERISA Standing Decision'The National Law Review In another development in the ongoing litigation over the enforceability of Independent Dispute Resolution (IDR) awards issued…...
Proposed Rule Eliminates Medicare Part D Notice for ICHRAs
1+ mon, 3+ week ago (386+ words) The Department of Health and Human Services (HHS) published a proposed rule on November 28, 2025 (the Proposed Rule) that would carve out account-based group health plans from the requirement to ... The Department of Health and Human Services (HHS) published a proposed…...
The Next Chapter of Medicare Advantage and Part D: Key Takeaways from the 2027 Proposed Rule
1+ mon, 3+ week ago (595+ words) On November 25, 2025, the Centers for Medicare & Medicaid Services (CMS or the "Agency) released the 2027 Medicare Advantage and Part D Proposed Rule (the "Proposed Rule). In this Insight, we provide an overview of the major components of the Proposed Rule and…...
Eleventh Circuit to Weigh the Constitutionality of the False Claims Act’s Qui Tam Provisions
1+ mon, 4+ week ago (1070+ words) On December 12, 2025, the U.S. Court of Appeals for the Eleventh Circuit is scheduled to hear oral arguments in Zafirov v. Florida Medical Associates LLC, No. 24-13581, a case that squarely presents the question of the constitutionality of the qui tam provisions of the…...
CMS Releases the Proposed 2027 Medicare Advantage and Part D Rules
2+ mon, 1+ week ago (783+ words) Last week, the Centers for Medicare & Medicaid Services (CMS) released its proposed Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program (Proposed 2027 Rules). Last week, the Centers for…...
OIRA Memo on Agency Deregulation - Implications for Health Care
3+ mon, 2+ day ago (224+ words) On October 21, 2025, the acting administrator of the Office of Information and Regulatory Affairs (OIRA) in the Office of Management and Budget issued'Memorandum M-25-36,'which contains guidance for federal agencies on "how to bolster, streamline, and speed" the deregulatory agenda prioritized by…...
Healthcare Litigation, Compliance, and Investigations Forum 2025
3+ mon, 1+ week ago (48+ words) Hosted By McDermott Will & Schulte LLP Location, or Event type: 444 W. Lake St., Chicago, IL 60606 " " " "Register In Person! "Register For Virtual ! Address: 444 W. Lake St., Chicago, IL 60606Date: Tuesday, October 28, 2025Format: In-person and virtual options available Register For Virtual !...
Texas Court Strikes Down CMS’s RADV Rule – CMS’s Treatment of Actuarial Equivalence and the FFS Adjustor Does Matter, After All
4+ mon, 1+ week ago (908+ words) In what will create a glimmer of hope for beleaguered Medicare Advantage Organizations (MAOs) who are facing looming waves of Risk Adjustment Data Validation (RADV) audits, on September 25, 2025, a Northern District (ND) of Texas District Court invalidated the Centers for…...
CMS Proposes Several Changes Affecting Telehealth Services in the 2026 Medicare Physician Fee Schedule Proposed Rule
5+ mon, 6+ day ago (1297+ words) On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2026 physician fee schedule (PFS)proposed rule, which in pertinent part proposes several changes affecting the delivery and reimbursement of telehealth services under the Medicare program....