The Centers for Medicare & Medicaid Services (CMS) has been using prior authorization for selected Hospital Outpatient Department (OPD) services for several years as part of its broader effort to curb improper payments and unnecessary utilization. In late 2025, CMS expanded that approach into the Ambulatory Surgical Center (ASC) setting through a new Prior Authorization
Healthcare Non-Competes: Fall 2025 Update
Since the last update regarding non-compete agreements in healthcare, there have been recent developments over the past few weeks, both in the courts and with the Federal Trade Commission (FTC), that have brought some clarity on restrictive covenants for healthcare professionals. At the federal level, the FTC is ramping up case-by-case enforcement, with a focus
What the Government Shutdown Means for Physicians
As of October 1st, the federal government is officially shut down after Congress failed to pass funding legislation. While the biggest direct impact will certainly be on furloughed federal workers and government agencies, if your practice relies on Medicare or Medicaid, or you are involved in research, there are ripple effects worth understanding.
What Stays
CMS Unveils 2026 Physician Fee Schedule Proposal: Key Changes Ahead
On July 14, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2026 Physician Fee Schedule. As expected, there are several meaningful updates that providers, practices, and health systems should be aware of.
One of the more significant changes is that CMS will split the conversion factor into two separate
DOJ and HHS Launch New False Claims Act Working Group to Target Healthcare Fraud
The U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have jointly announced the launch of a reinvigorated DOJ-HHS False Claims Act Working Group aimed at enhancing interagency coordination around key fraud enforcement priorities in the healthcare space. This initiative underscores the federal government’s ongoing reliance on the False Claims
DOJ Announces Largest Health Care Fraud Takedown in U.S. History
In the largest health care fraud takedown in U.S. history, the Justice Department announced charges against 324 individuals—including 96 licensed medical professionals—in connection with schemes involving over $14.6 billion in intended losses across 50 federal districts and 12 State Attorneys General Offices. The coordinated enforcement action led to the seizure of more than $245 million
Gov. Shapiro Signs Fair Contracting for Healthcare Practitioners Act Into Law
On July 17, 2024, Pennsylvania Governor Josh Shapiro signed the Fair Contracting for Health Care Practitioners Act into law, which will become effective as of January 1, 2025 (click here see the full bill). Any noncompete covenants that are greater than one year in length in an employment agreement for a healthcare provider, entered into
Non-Compete Ban Updates: FTC Rule Challenges & Pennsylvania Healthcare Legislation
Challenges to the FTC Rule
As we previously discussed on Med Law Blog, following the FTC’s approval of the final rule to ban non-compete agreements for for-profit businesses in April, several businesses have challenged the FTC’s authority to enforce this rule. The final rule is set to take effect on September 4, 2024, but in
Businesses Challenge FTC’s Ban on Non-Compete Agreements
As expected, businesses have sued the FTC challenging the recent final rule that ends non-compete agreements, as reported by the Wall Street Journal Wednesday morning (read WSJ article here). The U.S. Chamber of Commerce challenged the final rule in federal court in East Texas, which has been joined by other business groups. A lawsuit
FTC Votes to Ban Non-Compete Agreements
- This rule only applies to for-profit businesses, as is within the scope