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OIG Removes Federal Approval Gate for State Medicaid Fraud Data Mining
/in Fraud and AbuseBy Molly VandeVoort
*Disclaimer: The author used AI-assisted tools in preparing this alert, including for grammar and structural review and to cross-check citations. All substantive content, legal analysis, and conclusions reflect the author’s independent professional judgment.
On August 13, 2026, the U.S. Department of Health and Human Services Office of Inspector General (OIG) eliminated a longstanding federal checkpoint that has constrained how state Medicaid Fraud Control Units (MFCUs) deploy data analytics against Medicaid claims. Under State Fraud Policy Transmittal No. 2026-1 (the “Transmittal”), MFCUs no longer need OIG approval before conducting federally funded data mining, and they no longer need to renew that approval every three years. OIG accomplished the change by waiving the prior-approval requirements in 42 C.F.R. § 1007.20(a)(4) in their entirety. State fraud investigators can now move faster and look deeper into provider billing data using advanced analytics, machine learning, and other modern detection technologies—without first obtaining federal permission. Read more
Revamp of The No Surprises Act Federal Independent Dispute Resolution Process
/in Compliance, Healthcare Law, No Surprise Billing, Reimbursement & CollectionsBy Jake Walker
One of the most scrutinized aspects of the No Surprises Act has been the Federal Independent Dispute Resolution (“IDR”) process. According to data published by The Centers for Medicare and Medicaid Services (“CMS”), the number of disputes initiated between April 15, 2022, and May 31, 2026, was 6,336,0321. Of those disputes, 1,066,645 were found to be ineligible and 208,020 were closed due to other events (e.g., withdrawn by disputing parties, outside settlement, administrative closures)2. The total volume of disputes far exceeded initial projections by the relevant agencies, creating significant backlogs in the Federal IDR process.
As a result, the U.S. Department of Health and Human Services (“HHS”) (along with the Department of Labor and Department of the Treasury) (collectively, the “Departments”) published a final rule on June 4, 2026, addressing particular aspects of the Federal IDR process including issues with timely rendering of payment determinations, enhancing information sharing between relevant actors, and introducing clearer timeframes for certain steps in the Federal IDR process (the “Final Rule”)3. The Final Rule is effective August 3, 2026, with staggered applicability dates for specific provisions (as shown in the table provided below). The Final Rule represents the most comprehensive revision to the Federal IDR process since its establishment.
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HIPAA and Deceased Persons
/in HIPAABy Kim Stanger
The HIPAA privacy and security rules generally apply to protected health information of deceased persons as well as the living. Providers may generally use or disclose such information concerning deceased persons as follows:
1. Treatment, Payment, or Operations. As with living persons, HIPAA allows providers to use or disclose protected health information of deceased persons for purposes of treatment, payment, or the provider’s healthcare operations, unless the provider has agreed otherwise. (See 45 CFR §§164.506 and 164.522(a)). This may include treatment of other living relatives. As the Office for Civil Rights (OCR) explained, “disclosures of protected health information for treatment purposes—even the treatment of another individual—do not require an authorization; thus, a covered entity may disclose a decedent’s protected health information, without authorization, to the health care provider who is treating the surviving relative.” (OCR FAQ, available at https://www.hhs.gov/hipaa/for-professionals/faq/222/how-can-i-obtain-a-deceased-relative-medical-record/index.html). Read more
Nevada Pauses Medicaid Enrollments for DMEPOS Providers
/in Provider NetworksBy J. Malcolm (Jay) DeVoy
On April 16, 2026, the Nevada Health Authority (NHA) announced a temporary, statewide moratorium on enrolling new Durable Medical Equipment, Prosthetics, Orthotics, and Suppliers (DMEPOS) providers in Nevada’s Medicaid program (Medicaid). While the NHA’s notice does not expressly address revalidation of previously enrolled DMEPOS providers, it describes the moratorium applying only to “the enrollment of new [DMEPOS] providers,” without effect on those currently enrolled in the program.
Providers of DMEPOS distribute a wide range of medical equipment, ranging from FDA-approved medical devices such as skin grafts used in wound care, pacemakers, and metal implants used in treating bone injuries, to CPAP machines used to treat sleep apnea and common mobility aids such as walkers and wheelchairs. To obtain payment for providing these products to patients, DMEPOS providers may be enrolled in Medicare and state Medicaid programs. The moratorium effectively means DMEPOS providers not already enrolled in Nevada’s Medicaid program will not receive payment for these products. Read more
Changes to Idaho’s Minor Consent Law
/in Idaho Healthcare LawBy Kim Stanger
Idaho has amended its restrictive minor consent law effective March 31, 2026.1 A redline showing the changes is available at https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2026/legislation/H0860E1.pdf. The amendments address many of the concerns raised by the original act, but problems and questions concerning its application remain. Read more