Worldwide: Healthcare

The Federal Trade Commission has secured a landmark settlement with Caremark Rx LLC requiring the pharmacy benefit manager to overhaul its rebate-driven business practices that allegedly inflated insulin drug prices.

The Centers for Medicare & Medicaid Services has proposed a new framework requiring hospitals to submit mandatory provider-based attestations for off-campus outpatient departments, fundamentally changing how these facilities demonstrate compliance with Medicare requirements. With a January 1, 2028 implementation deadline, hospitals must navigate new National Provider Identifier requirements, centralized electronic submission systems, and detailed documentation processes that will significantly impact reimbu

Medical billing unbundling—the practice of separating comprehensive procedures into multiple billing codes—walks a fine line between legitimate coding practices and healthcare fraud. When does this common billing technique cross into illegal territory, and what role do whistleblowers play in exposing systematic abuse that costs government healthcare programs hundreds of millions annually?

The behavioral health sector faces a critical gap between patient need and treatment access, with only half of the 61.5 million US adults experiencing mental illness receiving care. As regulatory changes reshape reimbursement models and investors increasingly favor specialized, high-quality providers, organizations are pursuing platform-building strategies focused on integrated care delivery, operational excellence, and measurable clinical outcomes to capture growth opportunities across autism services, sub

The Centers for Medicare & Medicaid Services has proposed sweeping changes to Medicare enrollment regulations that would dramatically expand its authority to deny and revoke provider enrollments. These proposals introduce retroactive revocation powers, extended reapplication bars, and new grounds for enforcement actions that could fundamentally reshape program integrity oversight and increase compliance risks for healthcare providers, suppliers, and their investors.

The U.S. Department of Justice has intensified False Claims Act enforcement in the wound care industry, targeting allegedly medically unnecessary skin substitutes, improper billing practices, and kickback arrangements. With billion-dollar settlements and a record-breaking $6.8 billion in FCA recoveries for fiscal year 2025, federal scrutiny of manufacturers, distributors, and healthcare providers continues to escalate. How are recent Medicare reimbursement changes and regulatory concerns reshaping complianc

On July 14, 2026, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2027 Medicare Physician Fee Schedule (MPFS) proposed rule (the Proposed Rule)...

On July 8, 2026, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the “Make Hospital Food Healthier” Pledge, a voluntary program inviting hospitals to serve more nutritious meals to patients.

In this episode of Health-e Law, partner Sara Shanti and Erik Pupo from Guidehouse explore the critical intersection of healthcare data sharing and cybersecurity vulnerabilities. As healthcare systems embrace greater connectivity through initiatives like TEFCA, they face mounting cybersecurity challenges that demand proactive strategies and robust protection measures.