Hospice Audit Series: The Latest Developments and Strategies for Success in the Ever-changing Audit Landscape
On February 3, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued new Medicare Advantage Industry Segment-Specific Compliance Program Guidance (MA ICPG) for the MA industry and...more
The Centers for Medicare & Medicaid Services (CMS) published its “Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies” on...more
On February 3, 2026, the U.S. Department of Health & Human Services, Office of Inspector General (OIG), published the long-awaited Medicare Advantage Industry Segment-Specific Compliance Program Guidance (Medicare Advantage...more
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year (CY) 2027 Medicare Advantage (MA) and Part D Advance Rate Notice....more
The District of Massachusetts held a hearing on defendants’ motion to dismiss in United States ex rel. Shea v. eHealth, Inc., et al. (No. 21-cv-11777-DJC), a notable False Claims Act (FCA) case examining the intersection of...more
As of 2025, 54% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA). The average Medicare beneficiary had a choice of over 42 options in which to enroll in 2025, and the total number of plans was over 3,700...more
On December 16, 2025, the Office of Inspector General (“OIG”) for the U.S. Department of Health and Human Services (“HHS”) published the results of its audit of a Louisiana-based Medicare Advantage contract for Humana, the...more
Happy holidays! We are coming to the end of 2025, and what a year in healthcare it was! With a new administration, the Centers for Medicare & Medicaid Services (CMS) and other federal agencies have been extremely busy...more
Medicare Advantage (MA) continues to grow in enrollment, but understanding how coverage decisions are made – and what CMS requires – remains complex....more
In 2026, there are fewer prescription drug plans in Medicare Part D and higher premiums, even when offset by a multi-billion-dollar government premium subsidy; this degradation of the Part D market is likely attributable to...more
As the U.S. federal government shutdown continues into its third week, telehealth service providers have now been hurled off the telehealth cliff and into the abyss created by the September 30, 2025, expiration of Medicare’s...more
On September 25, 2025, the U.S. District Court for the Northern District of Texas issued a significant decision vacating a rule issued by the Centers for Medicare & Medicaid Services (“CMS”) that would have had far-reaching...more
Last week, on September 25, 2025, Judge O’Connor in the U.S District Court for the Northern District of Texas ruled in favor of Humana (the Humana Decision) and vacated the Centers for Medicare & Medicaid Services (CMS)...more
The Inflation Reduction Act (IRA) made significant changes to the Medicare drug programs. Although the IRA may have been intended to make medicines more affordable for beneficiaries and the federal government, DLA Piper has...more
Our Drug Pricing and Market Access team tracks recent developments in healthcare reform, the Medicaid Drug Rebate Program, the 340B Program, Medicare, and state law....more
For over a decade, the two-midnight rule has served as an important determinant of whether a hospital inpatient stay is reimbursable by Medicare, as well as a measure of protection for hospitals that treat patients over...more
Shortly following its announcement of sweeping changes to RADV audits, CMS shared industry guidance last week regarding upcoming deadlines for the submission of risk adjustment data corrections in advance of RADV sampling....more
The US District Court for the District of Minnesota has ruled that plaintiffs may proceed in a putative class action lawsuit brought against a Medicare Advantage organization (MAO) to challenge its alleged use of an...more
Value-based care (VBC) is a health care delivery model that has grown increasingly common in recent years. Perhaps unsurprisingly, this growth seems to have attracted the attention of government enforcement agencies...more
SB 1120 (the “Bill”), which takes effect on January 1, 2025, amends existing California law to adopt guardrails around the use of artificial intelligence tools for the purpose of utilization management. As discussed in a...more
On Dec. 11, 2024, the OIG issued a Special Fraud Alert (Alert) related to certain fraud and abuse risks associated with marketing arrangements between Medicare Advantage Organizations (MAOs) and health care professionals...more
On December 11, 2024, OIG issued a Special Fraud Alert to warn the industry about the fraud and abuse risks associated with abusive Medicare Advantage (MA) organization (MAO) and agent and broker relationships with healthcare...more
The HHS Office of Inspector General (“OIG”) released a Special Fraud Alert to inform health care professionals (“providers”) and Medicare Advantage Organizations (“MAOs”) about the OIG’s view of potentially abusive marketing...more
The Centers for Medicare and Medicaid Services (CMS) finalized material changes to the overpayment rules for Medicare Parts A, B, C, and D effective January 1, 2025. These changes create new ambiguity and practical challenges...more
On December 11, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) published a Special Fraud Alert warning against suspect payment arrangements involving the Medicare Advantage (“MA”) program...more