Health Law Daily Wrap Up, WORTH NOTING—Other Health Law litigation and regulatory developments, (Sep 8, 2025)

By WK Editorial Staff

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

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—OIG REPORTS: CMS should confirm it is receiving Medicare postoperative visit data on global surgeries when reporting is required (OIG Report, No. A-05-20-00027 (Aug. 27, 2025)).

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ properly dismissed the Provider's complaint because the Provider did not file a response to the order or submit an acceptable amended complaint within the established time frame (In re LCD Complaint:Trigger Point Injections, DAB No. CR6506, Dec. No. C-24-474 (July 16, 2024)).

COVERAGE—DAB DECISIONS: The ALJ properly dismissed the Provider's complaint because the Provider did not file an acceptable and valid Local Coverage Determination (LCD) complaint under the applicable regulations when the Provider did not provide the treating physician’s written statement, did not identify the specific provisions of the LCD that adversely affected her, and did not submit copies of clinical or scientific evidence to support her complaint. The ALJ also concluded that the Provider could not file another complaint challenging the same LCD for six months pursuant to 42 C.F.R. § 426.410(c)(3) (In re LCD Complaint:Trigger Point Injections, DAB No. CR6512, Dec. No. C-24-458 (July 25, 2024)).

ELECTRONIC HEALTH RECORDS—C.D. Ill.: The court granted in part and denied in part a motion to dismiss a class action claim alleging the hospital wrongfully embedded third-party tracking technology on its website as well as its web-based tools and services (Hannant v. Sarah D. Culbertson Memorial Hospital, No. 4:24-cv-04164-SLD-RLH (C.D. Ill. Aug. 20, 2025)).

HEALTH CARE REFORM—CBO REPORTS: Clarifications of Marketplace coverage and eligibility under Public Law 119-21 (H.R. 1) and the 2025 Marketplace Integrity and Affordability Rule (CBO Report (Aug. 25, 2025)).

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ affirmed that the Inspector General (IG) had properly excluded the Provider from participating in Medicare, Medicaid, and all other federal health care programs pursuant to Section 1128(a)(4) of the Social Security Act because the Provider had been suspended based on substance abuse that resulted in a Consent Agreement and Order acknowledging that the Provider was unable to practice professional nursing with reasonable skill and safety. The ALJ also affirmed an indefinite period of exclusion under 42 U.S.C. § 1320a-7(c)(3)(E) because the Provider had not asserted that her registered nurse license had been reinstated (Lisa Michelle Dyer, DAB No. CR6499, Dec. No. C-24-257 (July 1, 2024)).

CONTROLLED SUBSTANCES—DAB DECISIONS: The ALJ affirmed that the Inspector General (IG) had properly excluded the Provider from participating in Medicare, Medicaid, and all other federal health care programs pursuant to Section 1128(a)(4) of the Social Security Act because the Provider had been convicted of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. The ALJ also affirmed that the 8-year exclusion imposed by the IG was not within a reasonable range and reduced to a period of 7 years based on two aggravating factors and one mitigating factor (Bryant Pryor , DAB No. CR6502, Dec. No. C-24-87 (July 10, 2024)).

ADMINISTRATION OF MEDICARE/MEDICAID PROGRAMS—DAB DECISIONS: The ALJ affirmed the CMS's determination to revoke the Provider's Medicare enrollment and billing privileges pursuant to 42 C.F.R. § 424.57(e)(1) and 424.535(a)(1) because the Provider was not in compliance with the supplier standards established by 42 C.F.R. § 424.57(c) when the Provider could not show that it had been accredited by a CMS-approved accreditation organization. The ALJ also affirmed that the correct effective date for the revocation of the Provider’s Medicare enrollment and billing privileges was 30 days after the notice of the revocation was issued or mailed (DME – 10 Global Xpress, Inc. d/b/a Cost Plus Medical Supply v. CMS, DAB No. CR6501, Dec. No. C-23-734 (July 3, 2024)).

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