The New York Attorney General’s Office imposition of a $250,000 penalty on MVP Health Care for maintaining an inaccurate mental health provider directory riddled with “ghost” providers. The problem, however, extends beyond...more
11/10/2025
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
Managed Care Contracts ,
Medicaid ,
Medicare Advantage ,
Mental Health ,
Mental Health Initiatives ,
OIG ,
Regulatory Oversight
As of September 30, several temporary Medicare telehealth flexibilities that were put in place during the COVID-19 pandemic officially came to an end. One of the most significant changes involves the site requirement for...more
10/13/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Healthcare Facilities ,
Medicare ,
Medicare Part B ,
New Regulations ,
Patient Access ,
Physicians ,
Regulatory Oversight ,
Regulatory Requirements ,
Reimbursements ,
Telehealth ,
Telemedicine
The New York Attorney General’s office recently announced an agreement with MVP Health Care under which the insurer will pay $250,000 in penalties, fees, and costs to the state for maintaining an inaccurate mental health...more
9/8/2025
/ Consumer Protection Laws ,
Enforcement Actions ,
Fines ,
Health Care Providers ,
Health Insurance ,
Insurance Industry ,
Insurance Regulations ,
Mental Health ,
New York ,
Patient Access ,
Penalties ,
Regulatory Requirements ,
Settlement ,
State Attorneys General ,
Unfair or Deceptive Trade Practices
The U.S. Department of Justice recently issued a press release concerning a Statement of Interest that shields small businesses from being forced to provide medical coverage for gender dysphoria.
In Bernier v. Turbocam et...more
8/25/2025
/ Americans with Disabilities Act (ADA) ,
Denial of Insurance Coverage ,
Department of Justice (DOJ) ,
Disability Discrimination ,
Gender Dysphoria ,
Gender Identity ,
Religious Exemption ,
Religious Freedom Restoration Act (RFRA) ,
Self-Funded Health Plans ,
Self-Insured Health Plans ,
Sex Discrimination ,
Title VII ,
Transgender
The owner of Sublime Medical Transportation in Schenectady County, New York was recently sentenced to three to nine years in state prison for orchestrating a large Medicaid fraud scheme. Muhammed Adnan Saeed netted over...more
7/21/2025
/ Criminal Prosecution ,
Enforcement Actions ,
Financial Crimes ,
Fraud ,
Government Agencies ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Investigations ,
Medicaid ,
New York ,
Sentencing ,
State and Local Government ,
White Collar Crimes
Cigna filed a lawsuit on June 24 in Manhattan federal court accusing Bristol Myers Squibb of unlawfully blocking generic versions of its blood cancer drug, Pomalyst, from entering the market. The suit also names Celgene, a...more
7/3/2025
/ Anti-Competitive ,
Antitrust Litigation ,
Antitrust Violations ,
Bristol-Myers Squibb ,
CIGNA ,
Competition ,
Drug Pricing ,
Generic Drugs ,
Monopolization ,
Patent Infringement ,
Pharmaceutical Industry ,
Prescription Drugs
The Centers for Medicare & Medicaid Services (CMS) recently published a press release rescinding its June 2022 guidance concerning hospitals’ obligations to pregnant women under the Emergency Medical Treatment & Labor Act...more
6/13/2025
/ Abortion ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
EMTALA ,
Government Agencies ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
New Guidance ,
Regulatory Requirements ,
Reproductive Healthcare Issues ,
Rescission
Two Pennsylvania nursing home operators were recently sentenced in federal court to pay more than $15 million in restitution in a healthcare fraud case. Comprehensive Healthcare Management Services, the operator of Brighton...more
6/9/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Criminal Prosecution ,
Enforcement Actions ,
False Claims Act (FCA) ,
False Statements ,
Federal Funding ,
Healthcare Facilities ,
Healthcare Fraud ,
Nursing Homes ,
Pennsylvania ,
Settlement
On April 30, the Federal Bureau of Investigation (FBI) released a Public Service Announcement warning consumers about fraudulent discount medical scams. These scams typically involve deceptive offers for health insurance...more
5/30/2025
/ Consumer Protection Laws ,
Enforcement Actions ,
False Advertising ,
FBI ,
Fraud ,
Government Agencies ,
Health Insurance ,
Healthcare Fraud ,
Insurance Industry ,
Scams ,
State Attorneys General ,
Unfair or Deceptive Trade Practices
Just last week, we reported that the 2025/26 NYS Budget Bill did not include a provision that would have increased the requirements for seeking Department of Health (DOH) approval of a material healthcare transaction (which...more
5/22/2025
/ Acquisitions ,
Disclosure Requirements ,
Government Agencies ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Mergers ,
New Regulations ,
New York ,
Regulatory Requirements ,
Reporting Requirements ,
State and Local Government