Roy W. Breitenbach

The number of Independent Dispute Resolution cases between health care insurance plans and out-of-network providers has unexpectedly exploded since the process was established under the federal No Suprises Act in 2020,...more Recent litigation and regulatory challenges surrounding the Independent Dispute Resolution (IDR) process—including the Halo complaint and similar actions brought by managed care organizations—highlight growing scrutiny of...more The Centers for Medicare & Medicaid Services (CMS) plans a new hospice scoring system in fiscal year 2027 to track “indicators of potential inappropriate utilization, quality of care, and compliance concerns, holding...more The U.S. Department of Justice (DOJ) recently released its first-ever DOJ-wide Corporate Enforcement and Voluntary Self-Disclosure Policy (CEP) for criminal cases, designed to incentivize companies to come forward when...more