On May 28, the U.S. Department of Health and Human Services (HHS) finalized regulations intended to make the Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA) more efficient and transparent in helping to resolve out-of-network payment disputes between healthcare providers and payors.

Under the IDR process, insurers and healthcare providers both file…

Aspen Dental, one of the nation’s largest dental service organizations (DSOs), recently settled charges alleging violations of California’s corporate practice of medicine (CPOM) and unfair competition laws. This was not the first time similar charges had been lodged against Aspen Dental; in 2015, it entered into a settlement with the New York Attorney General after…

On May 27, in furtherance of the March 16, 2026 Executive Order on Eliminating Fraud, Assistant Attorney General Brett A. Shumate issued a memo titled “Accelerating Review and Enhancing Enforcement in Benefits Fraud Matters.” The Memo announced new measures by the U.S. Department of Justice (DOJ) to strengthen False Claims Act (FCA) enforcement…

Health care providers may want to offer free or discounted services to help patients, and that instinct may be good. Most providers, however, don’t think of “free care” as a kickback issue in the same way they might think about gifts or rewards as a kickback issue. They should, because the Office of Inspector General…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion (No. 26-09) regarding certain free treatment that would be offered to patients of a pediatric dental clinic. Specifically, the clinic planned to offer free comprehensive orthodontic treatment to one select patient per year.

As a general…

The U.S. Department of Justice (DOJ) recently announced a new initiative to enhance its working relationship with data miners who bring cases as whistleblowers under the False Claims Act (FCA). The initiative is dubbed “FOCUS,” an acronym for Fraud Oversight through Careful Use of Statistics. 

There has been a sharp increase in qui tam complaints…

On Thursday, May 28, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Ashley Algazi and Tim Gonzalez will present “Examining AI in Health Care: A Review of Key Strategic, Legal, and Regulatory Considerations.”

As AI technologies become more integrated into clinical, operational, and administrative functions, health care providers and their advisors face…

The U.S. Food and Drug Administration (FDA) recently approved Eli Lilly and Company’s oral GLP-1 receptor agonist, Foundayo (orforglipron), for chronic weight management in adults with obesity or those who are overweight with at least one weight-related condition.

The approval introduces a new oral treatment option in a space that has been largely dominated by…

On April 21, in a “Hearing on Protecting Patients and Taxpayers: Cracking down on Medicare Fraud,” the House Ways & Means Committee received testimony on hospice and home health fraud from Sheila Clark, President and Chief Executive Officer of the California Hospice and Palliative Care Association,[1] and Chris Deery, the Director of Corporate Fraud…