The number of medical record requests is surging, and they should not all be treated as routine paperwork. Before responding, you need to determine the type of request and who is asking for the records. Engaging an experienced health care attorney and documentation and coding compliance advisor can significantly reduce the stress of responding and impact the outcomes.
In a significant new decision, the Second Circuit held that indirect, downstream losses are too remote to support a civil RICO claim. The ruling could substantially limit insurers’ ability to bring sweeping RICO lawsuits seeking treble damages against providers, imaging centers, physician practices, pharmacies, and others.
CMS has proposed significant changes to Medicare payment and coverage policies for remote patient monitoring and remote therapeutic monitoring beginning in calendar year 2027. The proposed rule would substantially limit the use of third-party personnel in furnishing billable remote monitoring services, expand existing patient eligibility requirements, and establish a mandatory initiating visit.
A massive national health care fraud takedown effort that charged over 455 defendants with more than $6.5 billion in alleged fraud was announced on June 23, 2026 by the U.S. Department of Justice. Wound care providers featured prominently in DOJ’s announcement.
The New York State Department of Health has published a Full Public Notice requesting a five-year extension of the Section 1115(a) Medicaid Redesign Team demonstration, which expires March 31, 2027. While the State proposes to continue the full scope of Health-Related Social Needs services delivered through Social Care Networks, two structural changes could fundamentally reshape the funding landscape for community-based organizations: the end of federal infrastructure funding (including CBO capacity building grants) and a transition from non-risk payments to risk-based capitated funding controlled by Managed Care Organizations.