The Consolidated Appropriations Act, 2026, which was signed into law on February 3, 2026, includes a significant new requirement affecting off-campus hospital outpatient departments....more
2/5/2026
/ Attestation Requirements ,
Centers for Medicare & Medicaid Services (CMS) ,
Consolidated Appropriations Act (CAA) ,
Government Agencies ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
New Legislation ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Regulatory Requirements ,
Reporting Requirements
On December 1, the Centers for Medicare & Medicaid Services (CMS) announced the Advancing Chronic Care with Effective, Scalable Solutions Model (ACCESS), a 10-year voluntary alternative payment model (APM) that will pay...more
12/12/2025
/ ACOs ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Chronic Care Managment (CCM) ,
Digital Health ,
Fee-for-Service ,
Innovation ,
Medicaid ,
Medicare ,
Medicare Part B ,
Provider Payments ,
Reimbursements ,
Telehealth ,
Telemedicine ,
Value-Based Payments ,
Wearable Technology
On October 31, the Centers for Medicare & Medicaid Services (CMS) finalized the Ambulatory Specialty Model (ASM), a mandatory alternative payment model (APM) for select specialists who regularly treat heart failure or low...more
On July 16, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for the Ambulatory Specialty Model (ASM), a mandatory, five-year alternative payment model for select specialists who regularly treat...more
7/25/2025
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Deadlines ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
Innovation ,
Medicare ,
MIPS ,
Physician Fee Schedule ,
Physicians ,
Proposed Rules
On June 20, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion 25-04, in which it declined to approve a proposal by a medical device company (Requestor) to pay the...more
In 2024, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) provided useful insights to the healthcare industry regarding how it approaches various fraud and abuse issues in an...more
2/7/2025
/ Anti-Kickback Statute ,
Billing ,
Compliance ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Healthcare ,
Healthcare Fraud ,
Medicare ,
Medicare Advantage ,
OIG ,
Risk Management ,
Settlement ,
Stark Law ,
Telehealth
As some packed the skis and headed to their favorite slopes this winter season, it is hard not to see the analogies to the healthcare private equity (PE) transaction market as we ring in the New Year. Much like the Northern...more
On December 9, the Centers for Medicare & Medicaid Services (CMS) published revised regulations implementing the so-called 60-day rule, under which healthcare providers and other parties generally must report and return any...more
On March 12, the U.S. Court of Appeals for the Second Circuit issued an important decision that sheds light on the test for determining scienter under the federal Anti-Kickback Statute (AKS). The Second Circuit reasoned that...more
We are pleased to bring you our 12th annual Healthcare Fraud & Abuse Review. Our Review provides comprehensive coverage of the most significant civil and criminal enforcement issues facing healthcare providers. Each year, we...more
2/27/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medical Devices ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Settlement ,
Stark Law ,
Telemedicine
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is tasked with providing objective oversight to protect the integrity and promote the efficiency of Medicare, Medicaid, and more than...more
2/1/2024
/ Advisory Opinions ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Information Technologies ,
Healthcare ,
Healthcare Fraud ,
Healthcare Reform ,
Information Blocking Rules ,
Litigation Strategies ,
New Guidance ,
OIG ,
Regulatory Agenda ,
Telehealth
On January 3, the U.S. Department of Health and Human Services Office of Inspector General (OIG) posted Advisory Opinion 23-15, approving a physician practice consultant’s proposal to offer gift cards to its customers when...more
On January 3, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion No. 23-12, approving a physician-owned hospital’s offer to redeem over a two-year period the...more
1/10/2024
/ Advisory Opinions ,
Ambulatory Surgery Centers ,
Anti-Kickback Statute ,
Healthcare Facilities ,
Hospitals ,
OIG ,
Ownership Interest ,
Partnership Agreements ,
Physician-Owned Hospitals ,
Remuneration ,
Retirement ,
Stark Law
On October 13, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion 23-07, approving a physician practice’s proposal to pay its physician-employees a portion of the...more
10/19/2023
/ Advisory Opinions ,
Ambulatory Surgery Centers ,
Department of Health and Human Services (HHS) ,
Employer Liability Issues ,
Healthcare ,
Healthcare Reform ,
OIG ,
Physicians ,
Profits ,
Proposed Regulation ,
Safe Harbors
Funding Environment Toughest in 40 Years -
The consensus of the four members of a panel on funding and financing healthcare is that the environment is tougher than they experienced in the wake of the 2008 financial crisis....more
9/27/2023
/ Artificial Intelligence ,
Buyers ,
Digital Health ,
Financing ,
Funding ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Healthcare Reform ,
Innovation ,
Investment ,
Investors ,
Private Equity ,
Technology ,
Value-Based Care
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued Advisory Opinion 23-04, approving the per-booking fees healthcare providers pay a technology company for each new patient who...more
The Centers for Medicare & Medicaid Services (CMS) recently published updated data regarding settlements made under the Voluntary Self-Referral Disclosure Protocol (SRDP), an important mechanism through which providers may...more
Nearly 25 years ago, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) created a regulatory safe harbor to the federal Anti-Kickback Statute (AKS) for physician investment in...more
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) continues to offer valuable insights to the healthcare industry as to how best to approach increasingly complex healthcare fraud...more
4/11/2023
/ Advisory Opinions ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
OIG ,
Physicians ,
Request For Information ,
Self-Disclosure Requirements ,
Telemedicine ,
Wellness Programs
On March 23, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) announced a new, expanded frequently asked questions (FAQs) process. Although OIG has long maintained FAQs on...more
On January 23, the Centers for Medicare & Medicaid Services (CMS) released revisions to its Voluntary Self-Referral Disclosure Protocol (SRDP), an important mechanism through which providers may disclose actual or potential...more
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services recently posted Advisory Opinion 22-20, approving an acute care hospital’s arrangement under which its employed nurse practitioners...more
1/6/2023
/ Acute Facilities ,
Advisory Opinions ,
Anti-Kickback Statute ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Nurse Practitioners ,
OIG ,
Physicians ,
Remuneration ,
Stark Law
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services recently released a template that parties may use when preparing advisory opinion requests. The voluntary template provides a simple...more
On July 15, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System proposed rule...more
7/25/2022
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Exceptions ,
Hospitals ,
Investment ,
Outpatient Prospective Payment System (OPPS) ,
Payment Systems ,
Physician Ownership ,
Physicians ,
Self-Referral ,
Stark Law
On June 29, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services published Advisory Opinion 22-14, approving in part, and denying in part, a request from an ophthalmology practice...more