Overview

The President signed H.R. 1, the One Big Beautiful Bill Act (the “Act”), into law on July 4, 2025. In Section 71113, the Act restricts the flow of Federal Medicaid funds to certain “Prohibited Entities” for the one-year period following its enactment.

Section 71113 puts forth a set of specific criteria. The prohibition applies to any entity—and its affiliates, subsidiaries, successors, and clinics—that: 

  • As of October 1, 2025:
    • Will be an “essential community provider,” as defined by 45 C.F.R. § 156.235, that is primarily engaged in family planning services, reproductive health, and related care;
    • Will be structured as a 501(c)(3) nonprofit organization; and
    • Will provide abortions (except cases involving rape or incest or if the woman’s life is endangered); and
  • Received more than $800,000 in Federal and State Medicaid payments in fiscal year 2023.

The structure of Section 71113 has created considerable uncertainty. The restriction went into effect on July 4, 2025, but requires both a forward-looking assessment of the services a provider will provide as of October 1, 2025, and a backward-looking assessment of how much a provider received in Medicaid payments in 2023. This ambiguity has led to two separate legal challenges in the weeks following the Act’s enactment. As of July 28, 2025, the U.S. Department of Health and Human Services (“HHS”), HHS Secretary Kennedy, the Centers for Medicare and Medicaid Services (“CMS”), and CMS Administrator Oz are enjoined from enforcing, retroactively enforcing, or otherwise applying the provisions of Section 71113 against all Planned Parenthood health care providers pursuant to a preliminary injunction issued by the U.S. District Court for the District of Massachusetts.[1] On July 29, 2025, twenty-one state attorneys general and the Governor of Pennsylvania also filed suit regarding the constitutionality of Section 71113 in the U.S. District Court for the District of Massachusetts.[2]

Continue Reading Legal Challenges to the One Big Beautiful Bill Act’s Restrictions on Federal Medicaid Funding

On June 12, 2025, the Fifth Circuit ruled in Guardian Flight I[i] and Guardian Flight II[ii] that the No Surprises Act (“NSA”) does not confer a private right of action on parties to confirm an  Independent Dispute Resolution (“IDR”) award in court. The Fifth Circuit is the first United States Court of Appeals to weigh in on the issue, which has divided some district courts. On July 11, 2025 the Fifth Circuit denied Appellant’s request for en banc review of the Court’s finding that the NSA lacks a private right of action.[iii] The panel’s ruling is now final and controlling precedent for the Fifth Circuit unless overturned by the Supreme Court.

Continue Reading Not So Surprising: The Fifth Circuit Finds No Private Right of Action in the No Surprises Act

On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the Fiscal Year (FY) 2026 update to the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS). This annual update adjusts Medicare payment policies and rates for inpatient and long-term care hospitals.​

Continue Reading CMS Issues FY 2026 Hospital IPPS Proposed Rule and LTCH PPS Proposed Rule

On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the Fiscal Year (FY) 2026 update to the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS). This annual update adjusts Medicare payment policies and rates for inpatient and long-term care hospitals.​

Continue Reading CMS Issues FY 2026 Hospital IPPS Proposed Rule and LTCH PPS Proposed Rule

On July 2, 2025, the U.S. Department of Justice (DOJ) Civil Division and the U.S. Department of Health and Human Services (HHS) jointly announced the formation of a False Claims Act (FCA) Working Group. This new initiative underscores a coordinated federal enforcement strategy focused on identifying and addressing fraud in federally funded health care programs, particularly Medicare Advantage and Medicaid managed care. The announcement comes days after Matthew R. Galeotti, Head of DOJ’s Criminal Division, announced the results of the “largest coordinated health care fraud takedown in the history of the Department of Justice”  and the creation of a “Health Care Fraud Data Fusion Center” comprised of data specialists that will “break down information silos, using coordinated data analysis to enable our investigative teams to quickly identify and dismantle emerging fraud schemes.” Taken together, these announcements demonstrate the DOJ’s effort—in both civil and criminal divisions—to strengthen its collaboration with HHS to investigate and prosecute health care fraud.

Continue Reading DOJ and HHS Launch FCA Working Group: Heightened Enforcement Risk for Health Care Entities

OOn May 24, 2025, Robert F. Kennedy, Jr. and the Make America Healthy Again (MAHA) Commission are expected to submit the Make our Children Healthy Again Assessment to President Trump as required by the President’s February 13 Executive Order (EO) establishing the Commission.[1] The EO directed Secretary Kennedy and the MAHA Commission to assess potential contributors to childhood chronic disease in America, focusing on the American diet, absorption of toxic material, medical treatments, lifestyle, environmental factors, Government policies, and food production technique.

Continue Reading MAHA’s Vision for Healthier Diets: Awaiting Concrete Steps and Assessing Challenges 

Two recent federal cases are providing insight into what to expect in state court litigation related to information blocking, defined in the 21st Century Cures Act (Cures Act) as a practice that interferes with the access, exchange, or use of electronic health information. 

On March 12, 2025, the Fourth Circuit upheld the Maryland District Court’s preliminary injunction for the plaintiff in Real Time Medical Systems Inc. v. PointClickCare Technologies, 131 F.4th 205 (2025).  In sum, the Fourth Circuit agreed with the District Court that PointClickCare’s “use of indecipherable CAPTCHAs and choice to block certain users is illegal under the information-blocking provision of the federal Cures Act, which supports [Real Time’s] unfair competition claims” under Maryland law.  The Fourth Circuit relied in part on Intus Care, Inc. v. RTZ Assocs., Inc., Case No. 24-cv-01132, 2024 U.S. Dist. LEXIS 100190 (June 5, 2024), where a District Court judge found that a violation of the Cures Act would constitute an “independently wrongful” act sufficient to support a claim for intentional interference with prospective economic advantage under California law, even though the Cures Act lacks a private right of action.

Continue Reading Recent Federal Cases on Information Blocking Violations Pave Way for State Court Claims and Shed Light on Manner Exception

This year, thousands of individuals in Southern California were impacted by the Palisades Fire and Eaton Fire. The fires were the second and fourth most destructive in the state’s history.[1] In 2024, millions of individuals in the southeastern United States were impacted by Hurricanes Helene and Milton. These hurricanes made landfall less than two weeks apart, establishing a new record for the shortest interval between two significant hurricanes in Florida.[2] The Southern California wildfires and Hurricanes Helene and Milton exemplify the pattern of increasingly severe and frequent natural disasters attributed to a changing climate. Such climate-related disasters have profound implications for healthcare systems, underscoring the necessity for coordinated efforts between federal and state governments to ensure the continuity of healthcare services and access to medical care. As a result of the Southern California wildfires, over 700 people were evacuated from nursing homes and other care facilities.[3] In Florida alone, over 350 healthcare facilities were evacuated as a preventative measure against Hurricane Milton.[4] Hundreds of other healthcare facilities throughout the region faced evacuations, closures, and damage as result of the hurricanes. Preparedness and swift response measures at all levels of government are essential to safeguard lives in the face of natural disasters.

Continue Reading The Role of Federal and State Governments in Maintaining Healthcare During Natural Disasters

The United States Court of Appeals for the Seventh Circuit recently reversed the conviction of Mark Sorensen, the owner of SyMed Inc., a Medicare-registered distributor of durable medical equipment (DME), for alleged violations of the federal Anti-Kickback Statute (“AKS”).  This case, described by the court as one that “tests some of the outer boundaries” of the AKS, highlights the distinction between illegal kickbacks and lawful advertising payments under the AKS.

Continue Reading Seventh Circuit Clarifies Limits on Advertising Payments under the AKS

On February 28, the Department of Health and Human Services (HHS) announced that it was rescinding the Richardson Waiver, a policy in place since 1971 which said HHS would provide notice of proposed rulemaking in certain cases where it was not otherwise required to do so by law. This announcement signals a policy shift for the agency and suggests that where permitted by law, HHS will generally now issue rules relating to “agency management or personnel or to public property, loans, grants, benefits, or contracts” without providing notice and comment to stakeholders, and may otherwise find good cause to forego notice and comment procedures.

Continue Reading HHS Suggests It Will Provide Less Notice and Opportunity for Comment on Grant and Contract Rules