Friday, July 10, 2026

CMS is advancing a proposed rule that would mandate a new attestation process for off-campus outpatient departments claiming provider-based status. The rule would codify specific requirements for providers to certify compliance with Medicare’s provider-based department regulations, including space, staffing, and billing integration. This formalization, building on earlier compliance guidance, is part of the agency's broader efforts to enforce site neutrality and ensure that higher reimbursements for hospital outpatient settings are justified. The proposal will be subject to a public comment period. Review the proposed attestation criteria for any outpatient locations you operate to assess potential compliance exposure ahead of the final rule.

CMS has issued a reminder that hospitals with outreach laboratories must report private payer rate data for clinical laboratory tests by July 31, 2026. This annual data submission is required under the Protecting Access to Medicare Act (PAMA) to inform future Medicare Clinical Laboratory Fee Schedule rates. The reporting period covers payments made from July 1, 2025, through June 30, 2026. Failure to report can result in significant financial penalties. Confirm with your laboratory billing department that the data collection and submission process is on track to meet the month-end deadline to avoid CMS penalties that reduce future Medicare lab payments.

Sturgis Hospital in Michigan closed this week after years of financial strain and declining admissions, raising alarms about a broader crisis for rural providers. The closure follows similar trends in Vermont, where Brattleboro Memorial Hospital is shuttering its birthing center due to unsustainable financial losses. Rural hospitals face a convergence of pressures: stagnant Medicare reimbursement, a shift of procedures to outpatient settings, rising labor costs, and thin payer margins. For practices that refer to or depend on these facilities, the closures mean longer travel times for patients and potential interruptions in referral networks. Watch local hospital financial statements and state-level closure announcements for signs of instability in your region; consider diversifying referral pathways now.

Nevada's Medicaid program has initiated a targeted six-month fraud investigation and recovery effort, signaling intensified scrutiny of provider billing. The sweep follows a national enforcement action in which CMS suspended 1,079 providers after prosecutors charged 455 people in a $6.5 billion fraud scheme. State-level crackdowns like Nevada's typically focus on outlier billing patterns, high-cost services like personal care, and durable medical equipment. For practices with Medicaid exposure, this is a prompt to review internal compliance programs and ensure documentation supports all billed services. Monitor your state Medicaid agency bulletins for audit notices or policy clarifications; Nevada's program runs through the end of 2026.

The Department of Justice and HHS announced charges against 455 people in a $6.5 billion healthcare fraud takedown, leading CMS to immediately suspend 1,079 providers from Medicare, Medicaid, and CHIP. The enforcement action targeted schemes involving telemedicine, genetic testing, durable medical equipment, and opioid distribution. While the suspended providers are concentrated in specific geographic and service categories, the scale of the action signals continued aggressive use of program integrity tools. For independent practices, this underscores the importance of maintaining clean enrollment records and avoiding relationships with marketing companies that promise high patient volume for specific tests or devices. No direct action is required, but the suspension power is a reminder of the administrative consequences of fraud allegations.