Articles and Blogs

The Department of Justice (“DOJ” or the “Department”) is putting the False Claims Act (“FCA”) on an accelerated track. In a May 27 memorandum, the Department announced a shift toward faster qui tam review, earlier enforcement decisions and more aggressive identification of fraud involving federal benefits programs—signaling a sharper, more streamlined enforcement posture. The... READ MORE

On April 30, 2026, the U.S. Department of Justice (“DOJ”) announced the creation of the West Coast Health Care Fraud Strike Force to target health care fraud in Silicon Valley. Specifically, the strike force unites the District of Arizona, District of Nevada and Northern District of California Health Care Fraud Divisions. Background The Health... READ MORE

The Centers for Medicare & Medicaid Services’ (“CMS’s”) guidance governing Medicare Advantage marketing practices has continued to evolve over the past several years, with regulatory requirements shifting significantly across administrations. These changes reflect both the ongoing development of health care coverage models and differing policy priorities among governing parties. As a result, organizations involved... READ MORE

NATIONAL AHA urges FTC, DOJ to exclude hospital mergers from premerger notification requirements Amazon names former Amwell CEO as head of health services Bill proposes counting hospital observation stays toward Medicare eligibility for skilled nursing care Dr. Oz taps new CMS chief of staff From California to Minnesota, rural hospitals push to keep their... READ MORE

On May 22, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule regarding both Medicaid State directed payments (“SDPs”) and Medicaid fee-for-service reimbursement. The proposed rule is based on two distinct but reinforcing authorities: (i) section 71116 of H.R. 1 (a/k/a the “One Big Beautiful Bill Act”); and (ii) the... READ MORE

In April, the Centers for Medicare & Medicaid Services (“CMS”) released the FY 2027 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”) to update IPPS payment rates and uncompensated care payments, refine CMS’s definition of new GME residency programs, request input on new quality measures, expand the joint replacement payment model, CJR-X, on... READ MORE

On May 21, 2026, U.S. Citizenship and Immigration Services (“USCIS”) issued a policy memo titled Adjustment of Status is a Matter of Discretion and Administrative Grace, and an Extraordinary Relief that Permits Applicants to Dispense with the Ordinary Consular Visa Process (the “Policy Memo”). According to the Policy Memo, adjustment of status to Lawful... READ MORE

Health care enforcement is entering a data-driven era in which artificial intelligence (“AI”) and large-scale analytics increasingly shape how fraud is identified and pursued, as reflected in the U.S. Department of Justice’s (“DOJ”) launch of the Fraud Oversight through Careful Use of Statistics (“FOCUS”) initiative. Overview of the FOCUS Initiative On April 7, 2026,... READ MORE

NATIONAL After FDA commissioner departure, drug center head is out AHA Statement on House Health Subcommittee Hearing Examining Physician Fees, Payment Reforms AMA taps new COO from UnitedHealth Amid legal dispute, Leapfrog debuts ‘full transparency’ badges CMS finalizes ACA marketplace overhaul for 2027: 6 notes CMS pauses hospice, home health Medicare enrollments in fraud... READ MORE

On May 1, 2026, the Department of Health and Human Services Office of Inspector General (“OIG”) posted Advisory Opinion 26-09 (“AO 26-09”), which opines on a pediatric dental and orthodontic service provider’s (“Requestor’s”) proposal to offer free orthodontic treatment for one patient per year at each of Requestor’s three practice locations (the “Proposed Arrangement”).... READ MORE