Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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Foley Health Care Law

9 stories

Legal·8d ago

Warren, Wyden Introduce Bill to Ban Corporate Practice of Medicine Nationwide

In its September 25 publication, Foley & Lardner reports that Senators Elizabeth Warren, Ron Wyden, and Jeff Merkley, along with three House members, introduced the Stop Corporate Takeovers of Physicians Act on September 16, 2026. The legislation would impose federal restrictions on corporate practice of medicine (CPOM), targeting private equity ownership structures and management services organization (MSO) arrangements commonly used in physician practice acquisitions. If enacted, the bill would affect how private equity firms and corporate entities structure their investments in physician practices, potentially requiring restructuring of existing MSO-based transactions that rely on management agreements to circumvent state CPOM restrictions. The legislation matters for Medicaid managed care organizations and providers because many MCO networks include physician groups owned through MSO structures, and federal CPOM restrictions could disrupt network composition, provider contracting models, and care delivery arrangements.

Legal·12d ago

DOJ Revises Justice Manual to Strengthen False Claims Act Enforcement

On September 18, 2026, the Department of Justice announced revisions to the Justice Manual strengthening False Claims Act enforcement. The changes affect how DOJ pursues FCA cases, including potential modifications to dismissal policies and limitations on relying on sub-regulatory guidance as the basis for FCA liability. Healthcare providers, including those serving Medicaid beneficiaries, face increased enforcement scrutiny. The revisions took effect immediately upon announcement.

Legal·17d ago

DOL Warns Plans to Maintain Mental Health Parity Compliance Despite Non-Enforcement Posture

The Department of Labor, HHS, and Treasury have adopted a non-enforcement posture for the final Mental Health Parity and Addiction Equity Act regulations published in fall 2024, but are warning employers and health plans that compliance remains expected. The guidance signals that while the agencies are not actively enforcing the 2024 final rule, they continue to monitor mental health parity compliance more broadly. This creates compliance uncertainty for Medicaid managed care plans and other health plans that must determine which parity requirements remain enforceable and how to demonstrate compliance without clear enforcement standards.

Industry·23d ago

Foley Partner to Speak on Medicare and Medicaid Administrative Enforcement Trends

Foley & Lardner partner Judy Waltz will present on Medicare and Medicaid administrative enforcement trends at the California Society for Healthcare Attorneys Fall Seminar. The session will address emerging enforcement patterns affecting healthcare providers and plans. No specific date or enforcement details are provided in the announcement.

Legal·30d ago

DOJ Expands Fraud Enforcement Division with Added Staff and Data Resources

The Department of Justice's National Fraud Enforcement Division is expanding its fraud enforcement operations targeting recipients of federal funds, including Medicaid providers and managed care organizations. DOJ is increasing investigative staff and deploying enhanced data analytics capabilities to detect fraud, with particular focus on schemes involving foreign nationals and government program integrity. The expanded enforcement posture takes effect immediately, reflecting DOJ's renewed prioritization of fraud prevention and recovery across federal healthcare programs. Medicaid providers, health plans, and state agencies should anticipate heightened scrutiny of billing practices, program compliance, and financial arrangements.

Legal·86d ago

Court Dismisses False Claims Act Case on Medicare Advantage Marketing Practices

A federal court dismissed a sealed False Claims Act case alleging Medicare Advantage marketing violations. The relator attempted to characterize patient acquisition and outreach activities as fraudulent claims for payment. The dismissal demonstrates judicial skepticism toward FCA theories targeting marketing conduct rather than false billing. The outcome matters for Medicare Advantage plans facing similar qui tam allegations linking enrollment practices to improper payment.

Legal·103d ago

DOJ Intensifies Medicaid Fraud Enforcement Under Trump Administration

The Trump Administration has significantly increased enforcement focus on waste, fraud, and abuse in Medicaid over the past six months, with the Department of Justice prioritizing False Claims Act cases against Medicaid providers and managed care organizations. This heightened scrutiny follows longstanding federal efforts to recover improper Medicaid payments but marks a notable acceleration in enforcement activity. The increased DOJ attention raises compliance and financial risk for Medicaid managed care plans, particularly around billing accuracy, utilization management, and encounter data reporting. Plans should expect more qui tam investigations and potential enforcement actions.

Legal·117d ago

California Doctor Convicted in $45 Million Medicare Botox Fraud Scheme

A federal jury in the Central District of California convicted Dr. Violetta Mailyan for orchestrating a $45 million Medicare fraud scheme involving fraudulent Botox injection claims. The conviction reflects DOJ's increasing use of data analytics to identify and prosecute billing anomalies and fraud patterns in federal health programs. The case demonstrates heightened federal enforcement targeting suspicious billing practices, particularly for high-cost procedure codes and injectable medications. Medicaid managed care organizations face similar fraud detection scrutiny and should strengthen their claims review protocols and provider oversight mechanisms.

Legal·117d ago

DOJ Orders Fast-Track Review of Sealed Medicaid False Claims Act Cases

The Department of Justice announced May 27, 2026, that civil attorneys must prioritize and expedite sealed qui tam cases alleging fraud against Medicaid and other federally funded, state-administered benefit programs. Assistant Attorney General Brett Shumate directed DOJ Civil Division and U.S. Attorney's Office lawyers to fast-track these investigations. The directive applies immediately to pending sealed cases. This signals heightened federal enforcement scrutiny of Medicaid fraud allegations and may accelerate the timeline from complaint filing to government intervention decisions or unsealing.

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