By ROLF LOWE
Wachler & Associates, P.C.

On October 31, 2025, The Centers for Medicare & Medicaid Services (CMS) issued the final rule for the physician fee schedule (PFS) for calendar year (CY) 2026. The PFS is updated and published annually in the Federal Register. In addition to setting prices for Medicare reimbursement, the PFS also includes updated payment and coverage policies for Medicare reimbursable services and supplies, and the implementation of provisions from various Congressional Acts that have been passed over the previous years. The final rule adopted most of what was included in the proposed rule when it was released in July.

In a press release from CMS released on the same day as the final rule, Chris Klomp, CMS Deputy Administrator and Director of the Center for Medicare, stated that “CMS is reinforcing primary care as the foundation of a better healthcare system while ensuring Medicare dollars support real value for patients, and not the kind of waste or abuse that erodes trust in the system.” In addition, CMS also identified that they are aligning with Health and Human Services Secretary Robert F. Kennedy’s initiative to Make America Health Again by refocusing existing risk assessment payment policies on essential patient behaviors in order to reduce [Read More]

By NICOLETTE TABER & DUSTIN PLUMADORE
Dickinson Wright

 Recently, the Ninth Circuit Court of Appeals affirmed a conviction of a lab operator for violations of the Eliminating Kickbacks in Recovery Act (“EKRA”) in United States v. Schena. This ruling, the first ever appellate interpretation of EKRA, has notable implications for both the laboratory industry and the greater healthcare industry.

What is EKRA?

EKRA was enacted in 2018 as a component of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). EKRA makes it a federal crime to accept or pay kickbacks for referrals to recovery homes, clinical treatment facilities, or laboratories. Similar to the Anti-Kickback Statute, EKRA requires proof of “knowing and willful” intent of the unlawful behavior and is not a strict liability statute, like the Stark Law.

Unlike many federal fraud and abuse statutes, EKRA’s prohibitions are applicable to services covered by any health care benefit program – including those offered by private payors. Therefore, EKRA’s reach is broader than the Anti-Kickback Statute and Stark Law, which only govern federal health care programs such as Medicare, Medicaid, and TriCare. Additionally, nearly none of the Anti-Kickback Statute and Stark Law safe harbors and exceptions that laboratories typically rely upon apply to [Read More]

Rivet Suggests Opening Up Medicare For Those Who Want It

U.S. Rep. Kristen McDonald Rivet (D-Bay City)  described the United States’ health care system as being in a “crisis” that, in the long term, should include affordable insurance programs, which “likely means . . . a reasonable proposal that opens up Medicare for people who want it.”

Speaking in November during a press conference sponsored by Protect Our Care, Rivet advocated for a return of the Affordable Care Act tax credits that have kept health insurance rates steady and affordable for Americans. Without the tax credits, “millions of Americans” are at risk of going without health insurance, which will jack up rates for everyone else.

Rivet mentioned a small business owner who is opting to drop health insurance altogether and purchase only health care for her daughter because the One Big Beautiful Bill eliminated the credits, which made their medical coverage affordable.

“It’s heartbreaking,” she said, adding that Republicans in Washington D.C. are ignoring the problem by not bringing to the House floor legislation to address the situation.

“This is an emergency,” Rivet said. “It’s something that has to be dealt with right now, and that’s why we’re talking about the ACA tax credits, but it certainly isn’t an indication [Read More]

This story courtesy of MIRS, a Lansing-based news and information service.

If Congress discontinues tax credits that subsidize working-class employees who get their health insurance through the Affordable Care Act’s affiliated marketplace, costs could skyrocket, based on testimony taken at a recent state Senate committee meeting.

The Center on Budget and Policy Priorities projected that 94,800 small business owners in Michigan, as well as 60,700 individuals tagged as “self-employed,” received coverage through the marketplace.

Without the Enhanced Premium Tax Credits, healthier people receiving coverage through the ACA marketplace may drop their coverage as the price for insurance becomes prohibitive, making coverage even more expensive for those who need it.

Senate Health Policy Committee Chair Kevin Hertel (D-St. Clair Shores) called, through his SR 81, to permanently extend the tax credits, which are set to expire at year’s end. The Department of Insurance and Financial Services (DIFS) told Hertel’s committee, 530,000 Michiganders were enrolled in the ACA marketplace for “Plan Year 2025.”

“For 2024, nearly 90 percent of enrollees qualified for a subsidy, saving an average of more than $380 per month,” said Joseph Sullivan, director of DIFS’ office of innovation and research. “Failing to extend the enhanced tax credits beyond the end of 2025 will impact marketplace consumers out-of-pocket costs, and will have the biggest [Read More]

This story courtesy of MIRS, a Lansing-based news and information service.

The rate of children and adolescents receiving routine vaccinations is declining across the state, according to a new study published in the journal Pediatrics.

Routine vaccinations are shots for polio, measles, mumps and rubella for children and meningitis for teenagers, said Kao-Ping Chua, an associate professor at the University of Michigan who oversaw the study.

Researchers looked at data from the Michigan Care Improvement Registry from 2017 to 2023. The registry documents the vaccinations an individual has received, he said.

They found that childhood immunizations dropped from 75.7% to 66.8% during the study period, while adolescent immunizations fell to 74.5% from 80.7%.

The COVID-19 pandemic accelerated the already-declining childhood vaccination rates, Chua said.

However, COVID-19 did not have the same impact on teenage vaccination rates.

“The pandemic itself did not seem to alter that pre-existing decline,” he said. “It didn’t make it decline more quickly or less quickly. It just kind of continued on at its same rate.”

Economic status also played a part in the trend. Counties with a lower median household income and higher rates of residents without health insurance saw larger declines in vaccination rates.

The rate of decline was comparable between rural and urban counties.

“There were increased barriers to [Read More]

By AMANDA SEITZ & JULIE APPLEBY

One family in Virginia Beach, Virginia, just found out their health plan’s deductible will jump from $800 to $20,000 next year. About 200 miles north, in Maryland, another household learned they’ll pay $500 more monthly to insure their brood in 2026. And thousands of people in Idaho were greeted with insurance rates that’ll cost, on average, $100 more every month.

As shopping season opens for Affordable Care Act plans in some states, customers are confronting staggering costs for their health insurance next year. The extra federal subsidies put in place in 2021 that made coverage more affordable for millions of people will expire at the end of this year unless a gridlocked and idle Congress acts.

With Democratic and Republican lawmakers at an impasse, the federal government shut down on Oct. 1, spurred by the need for an estimated $353 billion over a decade to continue providing enhanced ACA subsidies for roughly 24 million people. Both sides have dug in, with Republicans saying Senate Democrats must vote to reopen the government before they’re willing to negotiate on the ACA’s costs.

If Congress does manage to strike a deal in the coming days or weeks to extend some subsidies, the prices and types of plans [Read More]

By KAITLYN DELBENE
Wachler & Associates, PC

This year has seen a continued emphasis within the federal administration on identifying fraud within the Medicare and Medicaid programs. Increasingly, audit findings, as well as other investigatory efforts by CMS and federal partners, are leading to healthcare fraud investigations. This trend has picked up steam in recent months, and CMS has made various announcements telegraphing its efforts to combat fraud and abuse in federal healthcare programs. Providers should be aware of enforcement trends and consider seeking a legal or compliance review of their documentation and billing practices.

In June 2025, the Justice Department and Centers for Medicare & Medicaid Services announced the results of an effort dubbed the 2025 National Health Care Fraud Takedown, describing it as “an precedented effort to combat health care fraud schemes that exploit patients and taxpayers.” The June press releases emphasized the coordination among federal and state agencies and reported charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals. Among the agencies that participated in the Takedown were the U.S. Attorneys’ Offices for the Eastern and Western Districts of Michigan, the Michigan State Attorney General’s Office, and the Michigan Medicaid Fraud Control Unit.

Certain areas of focus are apparent among [Read More]

By KIMBERLY J. RUPPEL
Dickinson Wright

It has been a busy year for the Federal Trade Commission’s (“FTC”) enforcement efforts against non-compete restrictive covenants in employment agreements.  During President Biden’s administration in 2024, the FTC issued a rule banning non-compete provisions in employment agreements with certain exceptions (the “Rule”).  That led to immediate litigation challenging the FTC’s authority.  Appeals were pending in two federal Circuits until early September of this year, at which time the FTC voluntarily withdrew both appeals, acknowledging the over-breadth of the Rule.  In doing so, the Trump administration’s FTC Chairman, Andrew Ferguson, indicated that the FTC would continue its enforcement actions on a case-by-case basis.

This statement was emphasized by simultaneously filing an administrative complaint against a national pet cremation company to prevent enforcement of non-compete provisions in nearly 1,800 employees’ contracts.  Those agreements restricted employees from working in the industry anywhere in the country for one year after separating from the employer, regardless of position or responsibilities.  Thus, hourly workers had the same restrictions as highly compensated executives.

According to the complaint, the employer (Gateway Services) is the largest pet cremation business in the United States, with over 100 locations servicing 17,000 veterinary clinic nationwide.  The FTC alleged the non-compete provisions are anticompetitive for [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Implicit Bias Training Removed From Health License Requirements Under Bill

The Department of Licensing and Regulatory Affairs (LARA) couldn’t require a health professional to complete an implicit bias training to obtain or renew a license under Rep. Matt Maddock (R-Milford)’s HB 4915 .

“Picture this, every state is like a large swimming pool. Some states have warm water, clear water, like Florida, some states like New York and California have murky water, cold water. And every state has to attract people and businesses, right? So everyone wants to jump into a nice, warm swimming pool with clear water. Unfortunately, Michigan has cold water with sharks in it. No one wants to go to Michigan. I think we should name this committee, the shark removal committee, removing the sharks in the swimming pool to make Michigan great again,” Maddock said in front of the House Economic Competitiveness Committee today.

Kurt Miceli, medical director of Do No Harm Action, testified that an implicit bias training takes about 2 to 3 hours to complete and must be re-taken for each new licensing period, which lasts about 2 to 3 years.

Miceli said the mandate stemmed from “the belief that such biases lead [Read More]

By PAUL NATINSKY

In the dizzying storm of deregulation and preposterous policy there is so much to sort that some small, but significant developments get only footnote treatment.

Far behind wholesale healthcare coverage cuts, fringe vaccine policy and a baseless assault on acetaminophen during pregnancy, lies Michigan Medicine and Corewell Health’s sudden discontinuance of gender-affirming care for transgender minors, reported by Crain’s Detroit Business Sept. 15.

Seems like just another liability-avoidant preemptive move by a company responding to pernicious and unpredictable federal policy. But it’s not. It’s worse.

Public pressure can work to limit—or reverse—coverage cuts, pediatricians and primary care docs can join together and press ahead with science-based vaccine schedules and push back on false autism narratives. Insurers can choose to stay invested in expert-curated vaccinations, recognizing they save the costs of treating the dread diseases they prevent.

But, “(Corewell Health) said it was discontinuing prescribing puberty blockers or hormone therapy to minors for gender affirmation ‘given the serious risk of legal and regulatory action.’” This means the health system has made a decision about the clinical services it will offer based directly on a hostile and decidedly unscientific political pressure.

Corewell is not alone. Crain’s reported in August that “Michigan Medicine, the University of Michigan’s health system, announced it [Read More]

By ANNA CLARK

This story first appeared in ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Just 15 months after receiving an award from the Centers for Disease Control and Prevention for excellence in community water fluoridation, the city of Grayling, Michigan, changed course.

With little notice or fanfare, council members voted unanimously in May to end Grayling’s decadeslong treatment program. The city shut down the equipment used to deliver the drinking water additive less than two weeks later.

Although it already paid for them, the town returned six unopened barrels of the fluoride treatment to the supplier.

Personal choice was the issue, said City Manager Erich Podjaske. “Why are we forcing something on residents and business owners, some of which don’t want fluoride in their water?” he said. He saw arguments for and against treatment in his research, he said, and figured that those who want fluoride can still get it at the dentist or in their toothpaste.

Drinking water fluoridation is widely heralded as a public health triumph, but it’s had critics since it was pioneered 80 years ago in Grand Rapids, about 150 miles southwest of Grayling. While once largely on the fringes, fluoridation skeptics now [Read More]

By NOAM N. LEVEY, KATHERYN HOUGHTON & ARIELLE ZIONTS

With the Trump administration scaling back federal efforts to protect Americans from medical bills they can’t pay, advocates for patients and consumers have shifted their work to contain the nation’s medical debt problem to state Capitols.

Despite progress in some mostly blue states this year, however, recent setbacks in more conservative legislatures underscore the persistent challenges in strengthening patient protections.

Bills to shield patients from medical debt failed this year in Indiana, Montana, Nevada, South Dakota, and Wyoming in the face of industry opposition. And advocates warn that states need to step up as millions of Americans are expected to lose insurance coverage because of President Donald Trump’s tax and spending law.

“This is an issue that had been top of mind even before the change of administrations in Washington,” said Kate Ende, policy director of Maine-based Consumers for Affordable Health Care. “The pullback at the federal level made it that much more important that we do something.”

This year, Maine joined a growing list of states that have barred medical debt from residents’ credit reports, a key protection that can make it easier for consumers to get a home, a car, or sometimes a job. The measure passed unanimously with bipartisan support.

An  [Read More]

By DANIEL AYYASH, ESQ.
Wachler & Associates, P.C.

Recently, the Centers for Medicare & Medicaid  released the calendar year (CY) 2026 Physician Fee Schedule (PFS) Proposed Rule, introducing sweeping changes to Medicare Part B payment policy. Among the most significant updates are those addressing Medicare telehealth policy and a restructuring of how Medicare pays for skin substitute products commonly used by wound care providers.

Medicare Telehealth Policy Proposed Changes

Changes to the Medicare Telehealth Services List

In the Proposed Rule, CMS proposes simplifying the current five-step process to determine if a service qualifies for the Medicare Telehealth Services List. Under the new process, CMS would only keep three criteria: the service must be separately payable under the PFS; the service must fall within the scope of certain federal laws regulating telehealth services; and the service must be deliverable through real-time, two-way interactive communication. This change aims to lower provider burden and speed up access to new telehealth services.

Based on the revised review process, CMS proposes adding five new services to the Medicare Telehealth Services List for CY 2026:

• Multiple-family group psychotherapy (CPT 90849)
• Group behavioral counseling for obesity (HCPCS G0473)
• Infectious disease consultation add-on for inpatient/observation visits (HCPCS G0545)
• Diagnostic analysis, programming, and verification of auditory osseointegrated devices (CPT [Read More]
  

By ERICA ERMAN
Dickinson Wright

Growing up, my family played an unusual game around the dinner table. After sharing about our days, my dad (also a health care attorney) would ask my sisters and me to argue. He’d pick a topic, such as why my younger sister should have a later bedtime than me, or what movie we should rent at Blockbuster, and then we’d each be given roughly three minutes to present our arguments and another minute for rebuttal. The most challenging (and fun) part of the game was that we always had to argue the side other than what we naturally would have wanted. As it turns out, my dad gave my sisters and me a gift with this game – the ability to think critically about a topic, and a lifelong tool for how to critique our own arguments to make them stronger and recognize the strengths and weaknesses of others’ arguments. My little sister and I both became attorneys (my older sister became an educator) and all three of us use these skills every day.

Learning to identify your opponent’s strongest arguments paves the way for the strongest defense and for resolution. Here are questions I ask regularly when evaluating a case:

If everything the [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Study Shows Opioid Harm Reduction Reduces Deaths, Hep C, Hospitalizations

A new Department of Health and Human Services study showed 37 harm reduction agencies and programs have reduced overdose deaths, hepatitis C infections, and hospitalizations of addicted people.

The study indicated that more than 550 people were saved through the use of naloxone in 2024 and that there has been a 36 percent reduction in overdose deaths between 2023 and 2024. Michigan has given out more than 1.3 million naloxone kits and nearly 34,000 overdoses have been reversed since the launch of the Naloxone Direct Portal.

“These are not just statistics. They are our neighbors, our family members and our friends,” said DHHS Chief Medical Executive Dr. Natasha Bagdasarian.

More than 13,000 hospitalizations were prevented because of injection drug use between 2018 and 2024. About 13,200 emergency room visits were prevented between 2018 and 2023.

More than 4,000 cases of hepatitis C were prevented between 2018 and 2024 through the use of syringe service programs. The programs have also prevented the spread of HIV and other infections passing through the blood, Bagdasarian said.

DHHS data attributed these to the 100 harm reduction locations run by 37 different harm [Read More]

By DAVID ARMSTRONG, ERIC UMANSKY & VERNAL COLEMAN

This story was originally published by ProPublica.

Veterans hospitals are struggling to replace hundreds of doctors and nurses who have left the health care system this year as the Trump administration pursues its pledge to simultaneously slash Department of Veterans Affairs staff and improve care.

Many job applicants are turning down offers, worried that the positions are not stable and uneasy with the overall direction of the agency, according to internal documents examined by ProPublica. The records show nearly 4 in 10 of the roughly 2,000 doctors offered jobs from January through March of this year turned them down. That is quadruple the rate of doctors rejecting offers during the same time period last year.

The VA in March said it intended to cut its workforce by at least 70,000 people. The news sparked alarm that the cuts would hurt patient care, prompting public reassurances from VA Secretary Doug Collins that front-line health care staff would be immune from the proposed layoffs.

Last month, department officials updated their plans and said they would reduce the workforce by 30,000 by the end of the fiscal year, which is Sept. 30. So many staffers had left voluntarily, the agency said in a press [Read More]