Last summer, I wrote about the Department of Justice (DOJ) and Department of Health and Human Services (HHS) launching a joint False Claims Act Working Group focused on Medicare fraud enforcement. At the time, the government identified several priority enforcement areas, including Medicare Advantage risk adjustment, kickbacks, drug and device arrangements, and the use of
The State-by-State State of Physician Non-Competes
A 50-state guide to physician non-compete laws, including states that ban or restrict physician non-competes and major changes affecting physicians in 2026.
Continue Reading The State-by-State State of Physician Non-Competes
Aetna Agrees to Pay $117.7 Million to Settle False Claims Act Allegations Over Medicare Advantage Upcoding
Last summer, I wrote about the DOJ and HHS relaunching their joint False Claims Act Working Group, with Medicare Advantage risk adjustment fraud listed as one of its top enforcement priorities. The Aetna settlement announced earlier this month is a direct example of that initiative delivering results.
What Happened
Aetna has agreed to pay $117.7
AI in the Exam Room: What WVU Medicine’s Abridge Rollout Means for Physicians
Artificial Intelligence continues to move quickly into the clinical workflow.
WVU Medicine recently announced that it is expanding its use of Abridge, an AI-powered transcription platform designed to generate clinical documentation during patient encounters. What began as a small pilot program in 2025 has now grown to more than 1,200 physicians, nurse practitioners, and physician
Presentation at PBI Health Law Institute on Telehealth, AI, and Physician Contracting: A Recap
I recently had the opportunity to speak at the Pennsylvania Bar Institute’s Health Law Institute in Philadelphia on the topic of “Navigating New Frontiers in Physician Practice: Telehealth, Artificial Intelligence, and Contracting.”
Healthcare law is entering a period of rapid change. Telehealth, artificial intelligence, and remote care models are reshaping how physicians deliver care
CMS Announces New Mandatory Payment Model Targeting Cardiologists for Heart Failure Care
The Centers for Medicare & Medicaid Services (CMS) recently announced a new payment initiative that will require certain cardiologists to participate in a value-based reimbursement model focused on heart failure care. This program, known as the Ambulatory Specialty Model (ASM), is scheduled to begin January 1, 2027 and will run through December 31, 2031.
The
Reminder: HIPAA Notices of Privacy Practices Must Be Updated By February 16, 2026
As we move closer to the February 16 deadline, this is a reminder for HIPAA covered entities to confirm they are on track to update their Notice of Privacy Practices (“NPP”) to comply with the finalized federal requirements governing substance use disorder (“SUD”) records under 42 C.F.R. Part 2 (read the Fact Sheet here).
CMS Launches ASC Prior Authorization Demo for Certain “High-Risk” Procedures: What ASCs and Surgeons Need to Know
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
CMS Finalizes Rule Closing Medicaid Provider Tax Loophole
The Centers for Medicare & Medicaid Services (CMS) has finalized a major Medicaid financing rule aimed at closing what the agency has described as a long-standing “healthcare-related tax loophole.” The rule, finalized on January 29, 2026, implements statutory changes enacted last summer and significantly restricts how states
2026 Medicare Physician Fee Schedule
The final Medicare Physician Fee Schedule for 2026 has now taken effect. Under the new rule, Center for Medicare Services (CMS) finalized two separate Medicare conversion factors depending on participation in a qualifying Alternative Payment Model (APM). For physicians who do not qualify as APM participants, the 2026 conversion factor is $33.4009, representing a 3.26%