On January 21, 2026, the Office of Inspector General (“OIG”) for the U.S. Department of Health and Human Services (“HHS”) submitted its Fall 2025 Semiannual Report to Congress, identifying investigative outcomes relating to HHS program administration and operations during the six‑month period from April 1, 2025 through September 30, 2025. Similar to
Sign‑On Bonuses to Employees: OIG Warns of Heightened Risk
The Office of Inspector General (“OIG”) recently issued advisory opinion 25‑12 (“the Opinion”), which addresses a home care agency’s plan to advertise and pay sign‑on bonuses to prospective attendant‑employees, many of whom are family members of Medicaid beneficiaries who would also select the agency for their relative’s Medicaid‑covered services. OIG
No Surprises Here! New York and Florida Courts Reject Provider Suits to Enforce NSA IDR Awards, Heightening Pressure for Appellate Review
In a pair of recent back-to-back rulings, Federal district courts in Florida and New York have held that the No Surprises Act (“NSA”) does not permit providers to bring private causes of action to enforce Independent Dispute Resolution (“IDR”) awards issued under the NSA. Following on the heels of earlier
DOJ Begins Issuing Demand Letters to Contractors Under New Civil Rights Fraud Initiative
[This blog post was originally published on Proskauer’s Government Contractor Compliance & Regulatory Update blog here.]
The U.S. Department of Justice (the “DOJ”), Civil Division, has started issuing Civil Investigative Demands (“CIDs”) to federal contractors and grant recipients, seeking detailed information about their diversity, equity, and inclusion (“DEI”) practices. This move is part
No Surprises Here! Payers Push Back on IDR Submissions, Opening New Front in NSA Implementation Landscape
On May 27, 2025, Blue Cross Blue Shield Healthcare Plan of Georgia (“BCBSGA”) sued several emergency physician groups and their billing agent, Halo MD, alleging abuse of the No Surprises Act’s (“NSA”) independent dispute resolution (“IDR”) process. The complaint claims the providers submitted ineligible claims, made false attestations, and inundated
DOJ Targets Gender‑Affirming Care under FDCA and FCA: Scrutinizes Off‑Label Drug Use and False Diagnosis Codes
Last month, the United States Department of Justice (“DOJ”) issued its “Civil Division Enforcement Priorities” memorandum, memorializing a shift from its predecessor administration’s policy on gender‑affirming healthcare (“DOJ Memo”). The DOJ Memo portends a significant rise in government investigations and False Claim Act (“FCA”) liability for suppliers and providers
No Surprises Here! Fifth Circuit Holds NSA Provides No Private Right of Action to Enforce IDR Awards, Deepening Judicial Divide on Award Enforcement Mechanisms
In a recently issued opinion, the Fifth Circuit has added yet another chapter to the growing debate over whether providers may seek judicial enforcement of Independent Dispute Resolution (“IDR”) awards issued under the No Surprises Act (“NSA”). In a much-anticipated decision, the Fifth Circuit has held that the NSA does
DOJ’s Civil Rights Fraud Initiative: Key Considerations for Health Care Providers
The Department of Justice’s (“DOJ”) May 19, 2025 “Civil Rights Fraud Initiative” memorandum, issued by Deputy Attorney General Todd Blanche (the “Initiative”), marks a consequential policy shift for False Claims Act (“FCA”) enforcement. The Initiative instructs every U.S. Attorney’s Office to “aggressively pursue” compliance with federal civil rights laws, as those laws have been interpreted by the Supreme Court under the 2023 Harvard admissions decision. The effect of this order is to treat a recipient’s knowing violation of federal civil rights laws as a “false claim” whenever that recipient has certified, impliedly or expressly, that it would comply with those laws as a condition of receiving federal dollars.
CMS to Immediately Begin Auditing Medicare Advantage Plans in Significant Expansion of Enforcement Efforts
On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced a significant expansion of its auditing efforts with respect to Medicare Advantage (“MA”) plans.
For newly initiated audits of MA plans, CMS will audit all eligible MA contracts for each payment year. Additionally, for audits already initiated
Disproportionate Impact: Supreme Court Narrows Disproportionate Share Hospital Reimbursement to Supplemental Security Income Cash Recipients
The U.S. Supreme Court has issued a significant ruling affecting hospitals that serve low-income Medicare beneficiaries, narrowing the interpretation of the Disproportionate Share Hospital (“DSH”) payment formula. In Advocate Christ Medical Center v. Kennedy, the Court determined that only Medicare patients who were eligible to receive a cash Supplemental