Despite acknowledging “weighty” constitutional questions, the Fifteenth Court of Appeals in Texas (the “Court”) refused to halt a Medicaid qui tam action against Novartis, holding that the company’s constitutional challenges to the Texas Medicaid Fraud Prevention Act (“TMFPA”) must be addressed through ordinary appellate review, rather than through extraordinary relief. In re Novartis Pharmaceuticals Corp., No. 15-25-00207-CV (Tex. App.—15th Dist. Apr. 30, 2026).
Background
Health Selection Group, LLC (“HSG”) brought a qui tam action against Novartis under the TMFPA,
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DOJ Announces New Strike Force Targeting Health Care Fraud on West Coast
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 Care Strike Force program is a traditional DOJ enforcement model that adds resources from other federal Districts to supplement the enforcement target. The Health Care
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CMS Revises Medicare Advantage Marketing Guidance for Scope of Appointment Forms
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 in Medicare Advantage marketing have faced a regulatory landscape marked by frequent and often substantial revisions.
Background and Context
Each fall, CMS releases a proposed
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New CMS Proposed Rule Would Impose a Payment Limit on Additional State Directed Payments and Establish a Payment Limit for ‘Targeted’ Medicaid Fee-for-Service Payments
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 Presidential Memorandum titled “Eliminating Waste, Fraud, and Abuse in Medicaid” (effective June 6, 2025).
The proposed rule would implement section 71116 by revising the SDP
Continue Reading New CMS Proposed Rule Would Impose a Payment Limit on Additional State Directed Payments and Establish a Payment Limit for ‘Targeted’ Medicaid Fee-for-Service Payments
Weekly Hospital Real Estate Briefing: More Info on WakeMed/Atrium Health Merger | Health Care Construction Industry Continues to Grow | AdventHealth Posts $23B in Operating Revenue
CMS Publishes FY 2027 IPPS Proposed Rule
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 a nationwide basis and introduce quality measures into the Transforming Episode Accountability Model (“TEAM”) program.
Increase to Payment Rates Under the IPPS
Following a rebasing
Continue Reading CMS Publishes FY 2027 IPPS Proposed Rule
Weekly Hospital Real Estate Briefing: 5 Reasons Why Hospital Systems Should Consider a Senior Housing Partnership
If you’ve been watching the real estate news over the past two years, you have probably noticed an increase in senior housing transactions. A number of the health care real estate investment trusts (“REITs”) and specialty REITs that have historically focused on nursing homes have pivoted to investing in senior housing communities that offer independent living, assisted living and memory care services. It seems like the major real estate investors can’t get enough of senior housing.
USCIS Limits Adjustment of Status to Applications Demonstrating Extraordinary Relief
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 Permanent Resident is a discretionary benefit not designed to supersede the regular consular visa-issuing process. This is a departure from the longstanding procedure for seeking
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DOJ’s Data-Driven FCA Enforcement Initiative Raises Stakes for Health Care Providers
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, DOJ launched the FOCUS initiative, a first-of-its-kind program formalizing the Civil Division’s engagement with data miners who file qui tam complaints under the False
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Straight Talk on Free Orthodontic Treatment: Key Takeaways from OIG Advisory Opinion 26-09
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”).
How the Proposed Arrangement Would Work
Requestor’s treating providers could nominate existing patients to receive the free service (the patients may not nominate themselves). Each
Continue Reading Straight Talk on Free Orthodontic Treatment: Key Takeaways from OIG Advisory Opinion 26-09
Weekly Hospital Real Estate Briefing: OIG Issues Advisory Opinion on Lease Arrangements | Health Care Construction Costs Level Out
CMS Proposes Changes to Graduate Medical Education in 2027 IPPS Proposed Rule
On April 14, 2026, the Centers for Medicare & Medicaid Services (“CMS”) published the Fiscal Year (“FY”) 2027 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (the “Proposed Rule”), which can be found here. Among other things, the Proposed Rule would make updates to Graduate Medical Education (“GME”) policies for teaching hospitals under the Medicare program. These updates include (i) modifications to the criteria by which a program is deemed a “new program” for Medicare funding purposes; (ii) clarification
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Indiana Medicaid Seeks Moratorium for ABA Provider Enrollment
Indiana Medicaid’s effort to rein in Applied Behavior Analysis (“ABA”) therapy costs has led to a proposed moratorium on provider enrollment. On May 7, 2026, the Indiana Health Coverage Programs (“IHCP”) announced it is seeking approval from the Centers for Medicare and Medicaid Services (“CMS”) to implement the statewide provider enrollment moratorium, beginning June 6, 2026, for both new ABA therapy group enrollments, as well as changes of ownership for existing ABA therapy agencies. If approved, the moratorium will
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CMS Moratorium on New Medicare Home Health and Hospice Enrollment
On May 13, 2026, as part of its ongoing effort to address home health and hospice fraud, the Trump administration announced a 6-month moratorium on new Home Health and Hospice enrollment, effective immediately. The federal register notice for home health and hospice is set to be published on May 15, 2026. In general, the moratorium will not impact the following providers:
- Newly enrolling home health and hospice agencies that submitted their Medicare applications prior to May 13, 2026;
- Changes
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FDA Issues RFI on AI-Enabled Optimization of Early-Phase Clinical Trials Pilot Program
On April 29, 2026, the U.S. Food and Drug Administration (“FDA” or the “Agency”) issued a Request for Information (“RFI”) seeking stakeholder input on a proposed pilot program evaluating the use of artificial intelligence (“AI”) to optimize early-phase clinical trials.
The initiative is intended to assess how AI-enabled technologies “can improve efficiency, speed and quality of decision-making” in Phase I and early Phase II clinical trial development, including through enhanced patient selection, dose optimization, safety monitoring and earlier go/no-go
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FDA Moves Toward Real-Time Clinical Trial Modernization
On April 28, 2026, the U.S. Food and Drug Administration (“FDA”) announced additional steps in its ongoing initiative to advance real-time clinical trial approaches, including proof-of-concept studies and a request for information supporting a planned pilot program focused on real-time or near-real-time clinical trial data capture and review (the “Announcement”).
FDA Commissioner Marty Makary, M.D., M.P.H., stated:
“For 60 years, we’ve been conducting clinical trials in the same way, where key data signals can take years to reach the
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