Health Law Daily Wrap Up, WORTH NOTING—Other Health Law litigation and regulatory developments, (Jul 27, 2026)

By WK Editorial Staff

A roundup of other items of interest to the Health Law community.

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ affirmed that the CMS properly revoked the Providers Medicare enrollment and billing privileges pursuant to 42 C.F.R. 424.535(a)(19) because the Providers affiliation with another Medicare-enrolled hospice through a shared medical director posed an undue risk of fraud, waste, or abuse to the Medicare program. The ALJ further concluded that the CMS properly placed the Provider on the CMS Preclusion List because the conduct underlying the revocation was detrimental to the best interests of the Medicare program, that the Provider was subject to a 10-year reenrollment bar, and that the ALJ lacked authority to review the length of the reenrollment bar or the duration of the Providers inclusion on the CMS Preclusion List (OneCare Hospice, LLC v. CMS, DAB No. CR6929, Doc. No. C-26-180 (July 9, 2026)).

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ affirmed that the CMS properly revoked the Providers Medicare enrollment and billing privileges pursuant to 42 C.F.R. 424.57(e)(1) and 424.535(a)(23)(ii) because the Provider failed to comply with Supplier Standard 22 under 42 C.F.R. 424.57(c)(22) by failing to obtain accreditation from a CMS-approved accreditation organization. The ALJ further concluded that the Providers subsequent accreditation did not cure the noncompliance existing at the time of the initial and reconsidered determinations, that a single violation of a supplier standard was sufficient to support revocation, and that equitable considerations did not provide a basis to overturn the revocation (Accudose Pharmacy v. CMS, DAB No. CR6924, Doc. No. C-26-10 (June 23, 2026)).

CIVIL MONEY PENALTIES—DAB DECISIONS: The ALJ affirmed the CMSs determination that the Provider was not in substantial compliance with the Medicare participation requirement pursuant to 42 C.F.R. 483.25 because the Provider failed to ensure that a resident received treatment and care in accordance with the residents care plan, professional standards of practice, and the Providers wound management policy, resulting in the failure to promptly identify and respond to the residents gangrene. The ALJ also affirmed that the CMS properly imposed a per-instance civil money penalty of $22,584 because the Providers noncompliance posed the potential for more than minimal harm, and the penalty amount was reasonable based on the applicable statutory and regulatory factors (Highland Pines Nursing Home v. CMS, DAB No. CR6922, Doc. No. C-22-646 (June 22, 2026)).

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ affirmed that the Inspector General (IG) properly excluded the Provider from participation in Medicare, Medicaid, and all other federal health care programs pursuant to section 1128(b)(4) of the Social Security Act because the Providers license was revoked or otherwise lost for reasons bearing on the Providers professional performance. The ALJ also concluded that the exclusion would remain in effect until the Providers license was reinstated because the Provider surrendered the license while a formal disciplinary proceeding was pending, the statutory criteria for exclusion were satisfied, and equitable considerations did not provide a basis to overturn the exclusion (Maria Blair v. The Inspector General, DAB No. CR6921, Doc. No. C-26-292 (June 17, 2026)).

FRAUD AND ABUSE—DAB DECISIONS: The ALJ affirmed that the CMS properly revoked the Providers Medicare enrollment and billing privileges pursuant to 42 C.F.R. 424.535(a)(19) because the Providers had affiliations with another Medicare supplier that posed an undue risk of fraud, waste, or abuse to the Medicare program based on the affiliated suppliers prior revocation for submitting false or misleading enrollment information. The ALJ also concluded that the CMS properly placed the Providers on the CMS Preclusion List because the underlying conduct was detrimental to the best interests of the Medicare program, that the ALJ lacked authority to review the five-year re-enrollment bar, and that the CMS also properly revoked the Medicare enrollment and billing privileges of one of the Providers pursuant to 42 C.F.R. 424.535(a)(5) because it was not operational (Ohio Wound Care Network v. CMS, DAB No. CR6911, Doc. No. C-24-27 (June 9, 2026)).

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ affirmed that the CMS properly denied the Providers Medicare enrollment pursuant to 42 C.F.R. 424.530(a)(3) and 424.530(a)(4) because the Provider was convicted of a felony financial crime that was detrimental to the best interests of the Medicare program and its beneficiaries and failed to disclose the conviction on the Providers Medicare enrollment applications. The ALJ also concluded that the CMS properly added the Provider to the CMS Preclusion List because the Providers felony conviction supported the 10-year preclusion period (Giang Din Nguyen, DAB No. CR6904, Doc. No. C-26-335 (May 27, 2026)).

CIVIL MONEY PENALTIES—DAB DECISIONS: The ALJ granted the CMS’ motion for partial summary judgment and affirmed that the CMS properly determined that the Provider was not in substantial compliance with Medicare participation requirements pursuant to 42 C.F.R. 483.25 and 483.25(k) because the Provider failed to timely transfer a resident to the hospital after a fall, failed to follow its own transfer policy, and failed to provide adequate pain management. The ALJ also concluded that a hearing was required to determine whether the Provider was in substantial compliance with 42 C.F.R. 483.10(i)(1)-(7) and whether the $1,985 per-day civil money penalty (CMP) remained reasonable because material facts remained in dispute (River Crossing of Edwardsville v. CMS, DAB No. 2026-26, Doc. No. C-23-484 (June 1, 2026)).

MEDICAL DEVICES—D. Minn.: Order granting in part and denying in part motions to dismiss products liability and APA claims regarding Medtronic's spinal-cord stimulator (Hayes v. Medtronic Inc., No. 0:25-cv-02125-PJS-ECW (D. Minn. July 14, 2026)).

GENERAL HEALTH CARE NEWS—OIG REPORTS: The National Institutes of Health administered Superfund appropriations during fiscal year 2025 in accordance with federal requirements (OIG Report, No. OAS-26-04-062 (July 14, 2026)).

ARTIFICIAL INTELLIGENCE—GAO REPORTS: AI for medical notes and coding (GAO Report, No. GAO-26-109116 (July 16, 2026)).

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