News & Analysis as of

Clinical Laboratories

McGuireWoods LLP

Medicare Billers Face First New Pricing in Years and Compressed CLFS Timelines

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On May 1, 2026, CMS published three interconnected Federal Register notices that set the stage for how Medicare will price clinical laboratory tests in calendar year 2027. They announce the rechartering and new membership of...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - July 20th - 23rd, Chicago, IL

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

Venable LLP

HHS OIG Advisory Opinion: “No Remuneration” Ends the AKS Analysis

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On February 18, 2026, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion 26-02 (AO 26-02), concluding that a proposed arrangement involving a management services...more

Akerman LLP - Health Law Rx

No Remuneration, No Problem: Favorable OIG Advisory Opinion Highlights Important Guardrails for Clinical Laboratories Affiliated...

Management service organizations (MSOs) with affiliated clinical labs and urgent care clinics should take note of newly identified guardrails that will facilitate their compliance with the federal Anti-Kickback Statute (AKS)....more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - June 22nd - 25th, Denver, CO

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - May 11th - 14th, New Orleans, LA

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

McGuireWoods LLP

Healthcare & Life Sciences Private Equity Deal Tracker: LongueVue Leads Investment in Apex Dental

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LongueVue Capital (LVC) has announced a strategic investment in Apex Dental Laboratory Group in partnership with Swaney Group Capital (SGC). Apex, founded in 2015 and headquartered in Waco, Texas, operates a network of 16...more

Stevens & Lee

CMS Soon Ending COVID Flexibilities for Clinical Labs

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During and after the COVID-19 Public Health Emergency, the Centers for Medicare & Medicaid Services (CMS) provided certain flexibilities and exercised enforcement discretion with respect to regulations affecting...more

Arnall Golden Gregory LLP

First Circuit Clarifies Clinical Laboratory Safe Harbor: Laboratories May Rely on Physicians’ Medical Necessity Determinations in...

Key Takeaways - First Circuit strengthens False Claims Act defenses for clinical laboratories. In United States ex rel. Omni Healthcare Inc. v. MD Spine Solutions LLC, the court held that laboratories may generally rely on...more

Morgan Lewis - Health Law Scan

Favorable OIG Advisory Opinion Underscores Ongoing Scrutiny of Ancillary Service Referrals

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...more

Robinson+Cole Health Law Diagnosis

Hospitals Face New Attestation and NPI Requirements for Off-Campus Outpatient Locations by January 1, 2028

The Consolidated Appropriations Act of 2026, HR 7148 (the Act), just signed into law on February 3, 2026, ended a brief government shutdown and includes multiple provisions with a critical impact on health care organizations....more

Butler Snow LLP

Urgent-Care Management Company-affiliated Lab Arrangement Clears AKS Scrutiny

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The Health and Human Services Office of Inspector General (HHS-OIG) recently issued a favorable advisory opinion (AO-26-02) stating that it would not sanction an urgent-care management company for operating a separate...more

King & Spalding

President Trump Signs Appropriations Act with Medicare and Medicaid Extenders into Law

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On February 3, 2026, President Trump signed H.R. 7148, the Consolidated Appropriations Act, 2026 (the “Bill”) into law. In addition to funding portions of the government through September 30, 2026, the Bill also includes...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

Laboratory Fraud: The Gift That Keeps On Giving

Every sector of the healthcare industry relies upon laboratory testing. Lab tests are used to diagnose virtually all illnesses and conditions ranging from the common flu to cancer. The average American receives their first...more

Bass, Berry & Sims PLC

A Band-Aid on PAMA: Appropriation Bill Delays Cuts & Reporting Period; Updates Data

On February 3, 2026, President Trump signed into law the Consolidated Appropriations Act, 2026 (H.R.7148), an appropriations act that provides funding for various agencies including the Department of Health and Human...more

Robinson+Cole Health Law Diagnosis

New Year Brings Old Obligations with a Recent Twist: PAMA Reporting is Back

After uncertainty over the last few months, the last few weeks saw potential changes to the Protecting Access to Medicare Act of 2014 (PAMA) under section 6226 of the Consolidated Appropriations Act of 2026. On January 20,...more

Dickinson Wright

The 9th Circuit’s EKRA Ruling: Implications For Behavioral Health and Clinical Labs

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Recently, the Ninth Circuit Court of Appeals affirmed a conviction of a lab operator for violations of the Eliminating Kickbacks in Recovery Act (“EKRA”) in United States v. Schena. Originally Published in Healthcare...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - March 23rd - 26th, Nashville, TN

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

Robinson+Cole Health Law Diagnosis

DOJ Enforcement of Clinical Laboratories: Trends from Q4 2025

The final quarter of 2025 saw continued enforcement actions against clinical labs and other related healthcare entities. The Office of Inspector General (OIG) and Department of Justice (DOJ) heavily focused on False Claims...more

Robinson+Cole Health Law Diagnosis

Eliminating Kickbacks in Recovery Act – 2025 Updates and Looking to 2026

The Eliminating Kickbacks in Recovery Act (EKRA), enacted in 2018 as part of the SUPPORT Act, established a criminal statute prohibiting payments for patient referrals related to recovery homes, clinical treatment facilities,...more

Robinson+Cole Health Law Diagnosis

Search Bars, Chatbots, and Tracking Pixels: Practical Steps Labs Can Take to Reduce CIPA Risk in 2026

Plaintiffs’ firms are adapting the California Invasion of Privacy Act (CIPA), a 1960s-era wiretapping statute, to modern web technologies such as pixels, chatbots, and session replay tools. For laboratories, the practical...more

Bradley Arant Boult Cummings LLP

First Circuit Holds That Labs Can Generally Rely on a Doctor’s Order as Proof of Medical Necessity Under the False Claims Act

Addressing an issue of first impression, the First Circuit has clarified the burden to satisfy the knowledge element required in False Claims Act (FCA) cases in the context of laboratory testing and Medicare fraud....more

Hendershot Cowart P.C.

Clinical Labs, You're Not the Medical Necessity Police: First Circuit Clarifies Lab Liability Under the FCA

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On December 1, 2025, the First Circuit Court of Appeals delivered a decision that should bring welcome relief to clinical laboratories facing False Claims Act (FCA) allegations. In United States ex rel. OMNI Healthcare,...more

Robinson+Cole Health Law Diagnosis

South Carolina Lab Settles False Claim Act Case – A Study on Commercial Reasonableness and Disguised Kickbacks

A clinical lab in Anderson, South Carolina, and its founder and CEO have agreed to pay a minimum of $6.8 million to settle a federal qui tam case based on allegations for paying illegal kickbacks to physicians in exchange for...more

Polsinelli

No Second-Guessing Required: First Circuit Limits FCA Liability for Clinical Labs

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Key Takeaways - Reliance on Physician Orders: Clinical laboratories may generally rely on physician orders to establish medical necessity and are not required to independently reassess clinical judgment....more

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