President Trump was sworn into office on Monday, promising swift action on several fronts. There is already a new Federal Trade Commission (“FTC”) Chair, Andrew Ferguson, with former FTC Chair Lina Khan expected to step down shortly. At the Department of Justice, Antitrust Division (“DOJ”), proposed AAG Gail Slater will need to be confirmed by the Senate before she can take the helm.
Continue Reading Looking Back and Looking Forward: Healthcare Antitrust in a New Administration: What Stays the Same and What Changes?

I’m honored to participate in the University of Miami’s Business of Health Care Conference on January 24, 2025. This highly anticipated event brings together leaders from the nation’s most influential health care organizations to discuss the evolving health care landscape under the incoming administration.
Continue Reading Health Care at a Crossroads: Insights from the Post-Election Health Care Conference

Navigating the Certificate of Need (CON) process in New York is no small task. It’s a critical gateway for healthcare providers, particularly in the long-term care sector, to establish, expand, or modify services. The laws and regulations governing this process—rooted in Articles 28, 36, and 40 of New York’s Public Health Law—are complex, ever-evolving, and often overwhelming for even the most seasoned professionals.
Continue Reading Inside the World of Long-Term Care Certificate of Need (CON): An Exclusive Opportunity

New York State has a long-standing commitment to supporting its most vulnerable populations through Medicaid-funded services for older adults and those requiring long-term care. However, rising costs and an increasingly complex healthcare landscape have created challenges that demand innovative solutions. As New York seeks to align its healthcare system with evolving needs, the time has come to adopt integrated care models that promote sustainability, efficiency, and improved outcomes.
Continue Reading Building a Smarter Long-Term Care System in New York

The U.S. Department of Health and Human Services (“HHS”) issued a Notice of Proposed Rulemaking (the “Proposed Rule”) on December 27, 2024, to significantly amend HIPAA’s Security Rule, which sets forth the security standards for the protection of protected health information by covered entities and their business associates. The Proposed Rule’s issuance was expected, especially in light of the growing number of health data breaches and disclosures of large scale foreign cyberattacks.
Continue Reading HHS’ Last-Minute Holiday Gift: Proposed Changes to the HIPAA Security Rule

Cyberattacks on healthcare organizations are on the rise, with the number of affected individuals nearly tripling between 2022 and 2024, according to data compiled by the Department of Health and Human Services Office for Civil Rights (“OCR”).[1] OCR data also reveals a 239% and 278% increase in hacking incidents and ransomware attacks, respectively, between January 2018 and September 2023.
Continue Reading New York Adopts Comprehensive Hospital Cybersecurity Requirements

As the shift toward value-based care continues to transform the healthcare industry, hospitals and health systems are increasingly utilizing incentive-based physician compensation structures. Incentive-based compensation often includes a combination of a base salary with a variable bonus component tied to performance metrics, with the metrics being chosen based on overarching organizational goals, such as improving quality of care and managing costs. With these aims in mind, hospitals and health systems often base bonus achievement on meeting certain objective metrics, such as patient satisfaction scores, productivity measures, adherence to clinical guidelines, cost-saving measures, or other quality indicators most applicable to the…
Continue Reading Navigating Gainsharing Pitfalls in Value-Based Models

Under the banner of strengthening consumer data protection, Texas is ramping up enforcement of its comprehensive data privacy act, sending a nationwide signal that Texas is serious about safeguarding the personal data of consumers.
Continue Reading Texas AG Targets Data Use Under New Privacy Law

The rising cost of prescription drugs under Medicare continues to pose significant challenges for seniors, a population that relies heavily on consistent and affordable access to medications. This issue underscores broader gaps in the healthcare system and highlights the critical need for legal, regulatory, and economic strategies that prioritize aging populations.
Continue Reading The Legal and Economic Realities of Medicare Drug Pricing: Navigating Opportunities and Challenges

Effective as of December 26, 2024, each nursing home facility (“Facility”) in New York State will be required to post its overall Centers for Medicare & Medicaid Services (“CMS”) rating, as well as its ratings for (i) health inspections, (ii) staffing and (iii) quality measures, on:…
Continue Reading Deadline Quickly Approaching for NY Nursing Homes and Owners/Operators Regarding CMS Star-Rating Postings

With only two weeks remaining in the year, Congress is considering a government funding deal (the “Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025” or the “Bill”) that includes a welcome holiday gift for health care providers and patients – an expansive health care package that would extend certain telehealth flexibilities promulgated during the COVID-19 public health emergency (“PHE”) for an additional two years. The extended telehealth flexibilities are currently set to expire on December 31, 2024. This extension would generally allow providers to continue to serve Medicare patients via telehealth consistent with the current practices.
Continue Reading Congress Extends Telehealth Flexibilities for Two More Years

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 initiatives of the Biden administration, the Proposed Rule incorporates many of the Administration’s broader policy priorities, focusing on equity, transparency, and modernization in healthcare delivery and oversight.
Continue Reading Key Proposals from the CY 2026 Medicare Advantage and Part D Proposed Rule

Yesterday, the OIG released a Special Fraud Alert related to: (1) marketing arrangements between Medicare Advantage Organizations (“MAOs”) and health care professionals (“HCPs”), and (2) arrangements between HCPs and MA plan agents and brokers. In the Alert, OIG states that these types of arrangements may implicate the Federal anti-kickback statute (the “AKS”) and could result in unfair competition and improper steering of Medicare beneficiaries. Despite flagging these concerns, the Alert fails to offer specific, practical guidance on the types of arrangements that would or would not violate the law, and therefore does little to alleviate industry-wide confusion as to how to…
Continue Reading Special Fraud Alert: Suspect Payments in Marketing Arrangements Related to Medicare Advantage and Providers