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...more
UPDATE: On January 12, 2026, the federal government announced it would drop its appeal of Judge Walker’s order blocking implementation of the Pilot Program and return it back to HRSA for reconsideration. In a court filing...more
The American Hospital Association (AHA), the Maine Hospital Association and four non-profit health systems (the Plaintiffs) have filed a lawsuit in the U.S. District Court for the District of Maine challenging the Health...more
On October 21, 2025, CMS released a Medicare Learning Network (MLN) Connects Newsletter announcing that the claims hold previously implemented due to the federal government shutdown had been lifted for the majority of...more
On September 9, 2025, the Government Accountability Office (GAO) published a report titled “National Coverage Determinations Are Generally Timely, but Improvements Are Needed” (the Report). CMS makes national coverage...more
On July 31, 2025, HRSA’s Office of Pharmacy Affairs (OPA) announced a voluntary 340B Rebate Model Pilot Program (Pilot Program). Currently, under the 340B program, covered entities purchase outpatient drugs at a discounted...more
On July 22, 2025, the Fourth Circuit published its opinion in United States v. Donald Booker, No. 23-461, affirming a 200-month prison sentence for the owner of United Youth Care Services, which billed North Carolina’s...more
To offset the cost of other provisions in the bill, the One Big Beautiful Bill Act (OBBBA) includes significant reforms to Medicaid, Medicare, and Affordable Care Act (ACA) premium tax credits that are expected to result in...more
On April 11, 2025, CMS proposed a rule that would update policies and payment rates used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for FY 2026 (Proposed Rule). The Proposed Rule also proposes...more
On January 3, 2025, OIG posted the results of an audit that found that Medicare could have saved $7.7 billion if critical access hospitals’ (CAH) payments for swing-bed services were similar to those of the fee-for-service...more
1/22/2025
/ Audits ,
Bi-Partison Balanced Budget Act (BBA) ,
Centers for Medicare & Medicaid Services (CMS) ,
Critical Access Hospitals ,
Fee-for-Service ,
Health Care Providers ,
Healthcare Costs ,
Healthcare Facilities ,
Hospitals ,
Medicare ,
OIG ,
Payment Systems ,
Rural Health Care Providers ,
Skilled Nursing Facility
On December 11, 2024, the Ninth Circuit struck down an HHS policy that boosted the wage index, and therefore the Medicare reimbursement rate, for hospitals in low-income communities in Kaweah Delta Health Care District v....more
12/20/2024
/ Administrative Procedure Act ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Hospitals ,
Interim Final Rules (IFR) ,
Medicare ,
Minimum Wage ,
Reimbursements ,
Summary Judgment ,
Wage and Hour
On November 1, 2024, Senators Bill Cassidy (R-LA) and Maggie Hassan (D-NH) released a framework titled “Lowering Health Costs for Seniors Framework” (the Framework). The Framework proposes site-neutral payment for services in...more
On September 24, 2024, OIG released a report recommending that CMS exercise additional oversight of remote patient monitoring (RPM) services provided to Medicare beneficiaries. Medicare reimburses RPM for any chronic or acute...more
On September 30, 2024, a federal district court in Florida held the qui tam enforcement provision of the False Claims Act (“FCA”), which permits private citizens to pursue actions in the name of and on behalf of the...more
10/11/2024
/ Appointments Clause ,
Article II ,
False Claims Act (FCA) ,
Federal Rules of Civil Procedure ,
Florida ,
Medicare ,
Officers of the United States ,
Qui Tam ,
Relators ,
SCOTUS ,
Take Care Clause ,
United States ex rel Polansky v Executive Health Resources Inc
On August 12, 2024, OIG announced the results of an audit of payments made to hospitals for inpatient claims with the Medicare Severity Diagnosis-Related Groups (MS-DRGs) that require ninety-six hours of consecutive...more
8/30/2024
/ Audits ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Extrapolation ,
Hospitals ,
Inpatient Billing ,
Inpatient Rehab Facilities ,
Medicare ,
OIG ,
Overpayment ,
Policies and Procedures