Health Law Advisor

In early March, word came that Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services (CMS) is investigating New York’s Medicaid program—claiming it is riddled with fraud and waste. The news came at the same time as Minnesota filed a federal lawsuit against Oz, CMS, the U.S. Department of Health and Human Services (HHS) and its secretary, Robert F. Kennedy Jr., for withholding Medicaid funding, accusing the federal government of “weaponiz[ing] Medicaid against Minnesota as a political punishment.”

On January 16, 2025, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) posted Advisory Opinion 26-01, offering clarity as to whether a manufacturer may waive patient cost-sharing amounts for certain insured individuals receiving its clinical diagnostic test without triggering liability under the Federal health care fraud and abuse laws.

Late last year, the case Shannon MacDonald, MD, et al v. Otto Sabando was filed in the U.S. District Court for the District of New Jersey. The plaintiffs claimed that New Jersey’s licensure restrictions on the use of telehealth were unconstitutional as they infringe on basic civil rights everyone has and therefore should be struck down. However, the defendants argued that the licensure of physicians is within the jurisdiction of states to decide and regulate such that New Jersey’s licensure laws do not violate the U.S. Constitution. EBG discussed the initial arguments in this ...

On April 1, 2024, the U.S. Department of Health and Human Services (“HHS”) released new guidance which requires hospitals to obtain informed consent from patients before practitioners, or medical or other students, perform important surgical tasks or sensitive or invasive procedures or examinations (“Guidance”). The Guidance aims to address increasing concerns over patient privacy, in particular the performance of sensitive examinations and invasive procedures on anesthetized patients.

The Guidance both revises the Hospital Interpretive Guidelines regarding ...

Use of telehealth services has surged since the COVID-19 pandemic; however, this increase in use does not come without limitations. Telehealth providers are subject to regulations, which differ by state, that govern various aspects of providing services via telemedicine, including what types of health care providers can provide telehealth services, what services can be provided via telehealth, and where providers must be located in order to provide telehealth services to a patient. A requirement consistent across most states is that providers engaging in telehealth services ...

On January 9, 2024, the Center for Medicare and Medicaid Services (CMS) sent a letter to New York’s Medicaid director approving New York’s Section 1115 Waiver amendment, which the state submitted for approval on September 2, 2022. During the term of the amendment (January 9, 2024 through March 31, 2027), New York aims to fundamentally reform the way health care services are delivered through its Medicaid program by:   

1. Investing in Health Related Social Needs (HRSN) via providers working with Social Care Networks (SCNs) which in turn contract with existing Medicaid managed care ...

Beginning June 21, 2023, New York State (NYS) Public Health Law (PHL) Section 2830 requires hospitals and healthcare professionals to provide written notice to patients before the patient is charged a facility fee.

Overview of Hospital Billing

Billing by hospitals and certain medical facilities typically involves a combination of a facility fee and a professional fee. Facility fees account for the overhead costs of maintaining a hospital, or other health care facility, and refer to the payments for services provided by the hospital, or other health care facility, for either ...