The Medicare and Medicaid provider auditing process is about to get its own makeover in 2025. I am talking about artificial intelligence, which will be more accurate than our auditors pre-2025. The Medicare provider auditing process has evolved significantly in recent years, and several key trends are expected to shape the landscape in 2025. These
Key Proposals from the CY 2026 Medicare Advantage and Part D Proposed Rule
On November 26, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the contract year 2026 proposed rule for the Medicare Advantage (“MA”) program, Medicare Prescription Drug Benefit Program (“Part D”), Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (the “Proposed Rule”). Likely one of the last significant Medicare reform
Healing the Healers: Using Value-Based Care Strategies to Mitigate Physician Burnout
Where Physician Burnout and Value-Based Care Intersect
This series explores legal issues related to physician burnout and potential solutions, and here we explore the potential impact of value-based care (“VBC”). Our first post addressed how healthcare organizations can foster the psychological safety and emotional well-being of their physicians. Our second post discussed artificial intelligence solutions
NYDFS Highlights Strategies to Combat AI Cybersecurity Risks
The increased use of artificial intelligence (AI) in the banking, insurance, and financial services industries has led the New York State Department of Financial Services (NYDFS or Department) to publish an Industry Letter on October 16, 2024, that highlights cybersecurity risks resulting from the use of AI, the dangers posed by threat actors utilizing AI,
Virtual and Digital Health Digest – November 2024
This digest covers key virtual and digital health regulatory and public policy developments during October and early November 2024 from the United Kingdom and European Union.
Regulatory and legislative reform is on the horizon in both the UK and in the EU, which will impact software and artificial intelligence (AI) medical devices. The UK government
Practice & Procedure: Generative AI practice note.
Practice Note SC 23 (Link to Supreme Court NSW)
Use of Generative Artificial Intelligence (Gen AI)
With thanks to Justine Anderson for drawing attention to NSW Supreme Court Practice Note SC 23, issued today with a view to commencement on 3 February 2025. Associated amendments to the Uniform Civil Procedure Rules will also come
New York State Department of Health Adopts Hospital Cybersecurity Regulations
Keypoint: With the increased frequency and severity of cyberattacks against healthcare systems, state and federal agencies strive to improve cybersecurity controls with varied success.
In November 2023, New York Governor Kathy Hochul announced proposed regulations that would be the first state regulations for hospitals in New York. The governor described the proposed regulation as a
The Convergence of Life Sciences and Artificial Intelligence: Seizing Opportunities While Managing Risk
A new report commissioned by Arnold & Porter, based on a survey of 100 senior executives and department heads from biopharmaceutical, digital health, diagnostics, and medical device companies, shows that artificial intelligence (AI) adoption is accelerating across the industry as companies implement it to accelerate product discovery and development, optimize manufacturing and the supply chain,
California Limits Health Plan Use of AI in Utilization Management
California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to treatments by mandating a certain level of health care provider oversight when payors use AI to assess the medical necessity of requested medical services, and
Stringent Requirements for Pleading Fraud Under Rule 9(b).
Dr. John Pepe and Dr. Richard Sherman (“Relators”), acting as whistleblowers, brought a qui tam action against Fresenius Medical Care Holdings, Fresenius Vascular Care, Inc., and Dr. Gregg Miller (“Defendants”). Relators’ complaint alleged that the Defendants engaged in fraudulent billing practices under the False Claims Act (“FCA”) and analogous state laws. Last week, the United