Articles and Blogs

On January 1, 2025, the Centers for Medicare and Medicaid Services’ (“CMS”) new 60-Day Rule became effective. The 60-Day Rule states several changes, with some changes significantly impacting False Claims Act (“FCA”) liability. Background CMS’s 60-Day Rule is a regulation under the Affordable Care Act (“ACA”) that requires health care providers and suppliers to... READ MORE

On August 17, 2020, just one day before a Health and Human Services (“HHS”) Patient Protection and Affordable Care Act (“ACA”) rule retracting discrimination protections for transgender people and pregnant women (“2020 Rule”)[1] was set to go into effect, Judge Frederic Block of the U.S. District Court in the Eastern District of New York... READ MORE

On March 2, 2020, the Supreme Court agreed to hear a case directly challenging the constitutionality of the Affordable Care Act (“ACA”),[1] but it is likely that the fate of ACA will not be decided before the 2020 presidential election. In Texas v. United States[2], multiple plaintiffs challenged the ACA in the District Court... READ MORE

Supreme Court Agrees to Hear ACA Validity Case Today, the Supreme Court agreed to hear a third major Affordable Care Act (“ACA”) case. The Court will consider whether a legislative change to the ACA’s individual mandate rendered the landmark law unconstitutional. Learn more from a recent Hall Render article here. By granting petitions from... READ MORE

On January 21, 2020, the Supreme Court denied a motion to expedite consideration of a petition for certiorari in a case directly challenging the constitutionality of the Affordable Care Act (“ACA”).[1] Given the Supreme Court’s decision, it is likely that the fate of Obamacare will not be decided until sometime after the 2020 presidential... READ MORE

On December 18, 2019, in a 2-1 decision, the U.S. Court of Appeals for the Fifth Circuit held that the plaintiffs in Texas v. United States[1] had standing to bring a case challenging a provision of the Affordable Care Act (“ACA”) known as the individual mandate (26 U.S.C. §5000A) and that the individual mandate requiring... READ MORE

A federal district court in Connecticut recently applied the Supreme Court’s favorable opinion in the Allina case (which we previously wrote about here), compelling the Secretary to adhere to notice-and-comment rulemaking of Medicare policy when it affects providers’ eligibility, benefits or payment. Additionally, CMS cannot use a preclusion statute to avoid challenges for which it did not... READ MORE

On June 14, 2019, the U.S. Department of Health and Human Services (“HHS”) published in the Federal Register a proposal to revise certain civil rights anti-discrimination regulations implementing and enforcing Section 1557 of the Affordable Care Act (“ACA”) (“Section 1557 Rule”) that HHS believes are inconsistent with pre-existing civil rights statutes and likely unlawful... READ MORE

HELP Committee Leaders Release Draft Bill Targeting Health Care Priorities Senate Health, Education, Labor, and Pensions (“HELP”) committee leaders Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) released a wide-ranging draft bill addressing health care issues such as surprise medical billing, prescription drug costs and urgent public health concerns. The proposal is separated into... READ MORE

Lawmakers Seriously Pursuing “Surprise Medical Bill” Fix Continuing the bipartisan interest in addressing the issue of surprise medical billing, also known as balance billing, a group of bipartisan senators led by Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) introduced legislation on Thursday. The legislation states that providers would be prohibited from balance billing... READ MORE