EPA Announces Availability of Updated Interim Maps Developed under Its Endangered Species Protection Program
On June 12, 2025, the U.S. Environmental Protection Agency (EPA) announced the availability of updated refined interim core maps that identify areas that EPA states are important to 12 threatened or endangered (listed) species and their critical habitats as designated by the U.S. Fish and Wildlife Service (FWS). These refined interim maps are based on information developed by FWS and were developed by EPA’s Office of Pesticide Programs (OPP), the Center for Biological Diversity (CBD), and Compliance Services International (CSI). The maps identify areas where listed species are likely to be located and areas where they are not, thus attempting to ensure that measures to protect listed species are only required in the areas where listed species are located. According to EPA, releasing these maps is “another important step to reduce potential impacts to farmers while continuing to protect endangered species.” EPA states these maps will be used for developing pesticide use limitation areas (PULA), which EPA notes will allow it to protect listed species from the use of pesticides through geographically specific mitigations.
According to EPA, when developing a PULA for a specific species, it starts by developing a core map identifying areas where listed species need additional protection. A core map may include information regarding:
The species range;
Its designated critical habitat; or
Other locations where the species is known to occur.
If existing range maps are broad and include areas where a species is no longer thought to exist, the core maps would only include areas within the species range where the species are likely to occur. After developing a core map for a species, EPA states it would develop a PULA that accounts for pesticide movement from a use site, such as spray drift and run-off, by adding adjacent areas to the core map. Developing a core map or a PULA does not alter FWS’s range maps.
According to EPA, it released its mapping process in anticipation of public interest in developing species maps. If a draft map was not developed specifically by EPA, it will review the draft map to ensure that (1) the map and documentation are consistent with EPA’s process; (2) areas included or excluded from the map are consistent with the biology, habitat, and/or recovery needs of the species; (3) data sources are documented and appropriate; and (4) the Geographic Information System (GIS) data and mapping process are appropriate and are identifying the types of areas that the map developer is intending to identify.
The maps released are considered interim maps, which means that “the maps were developed using EPA’s process and that EPA has reviewed them and agree that the maps are reasonable and can be used to develop pesticide use limitation areas.” These maps will be considered final after review by FWS species experts.
Information on the interim core maps can be found on EPA’s “Process EPA Uses to Develop Core Maps for Pesticide Use Limitation Areas” and maps can be viewed here. EPA notes it expects that dozens more refined maps will be released within the next several months.
Commentary
The maps, and then the PULAs, are among the more potentially controversial elements of the developing EPA program. If the PULA is too large, there will be criticism that EPA has “over-regulated” restricting pesticide use providing no additional species protection. If the PULA is too small (e.g., missing some of the habitat that should be included), then there will be criticism that the EPA plan would not be sufficiently protective. The maps and how they are proposed, evaluated, and refined may be the most fluid element of EPA’s proposed label restrictions. Where EPA might propose restrictions in an area that some current product users believe is essential for their cropping system, the appropriateness of the PULA will be subject to more scrutiny and possible changes. Not unlike what EPA has done historically when human health “risk-cup” issues arose, EPA’s conservative assessments will be subject to refinement before final mitigation restrictions are imposed on the revised label as part of registration reviews.
OFCCP Extends Enforcement Moratorium for VAHBP Providers Until 2027
In a move the Agency reported is designed to maintain healthcare access for active and retired service members and their families, the Office of Federal Contract Compliance Programs (OFCCP) has announced a two-year extension to the enforcement moratorium for Veterans Affairs Health Benefits Program (VAHBP) providers. This extension, effective June 11, 2025, will now run through May 7, 2027.
The extended moratorium continues to suspend the enforcement of VAHBP providers’ requirement to take affirmative steps to ensure equal opportunity without regard to disability or protected veteran status, obligations typically required of federal contractors and subcontractors. Additionally, VAHBP providers will not be subject to neutral scheduling for compliance evaluations during this period – though all evaluations are currently being held in abeyance.
Presently, the OFCCP retains authority to investigate discrimination complaints filed under Section 503 of the Rehabilitation Act (Section 503) and the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRAA). However, given the current administration’s focus on deregulation and the recent proposed budget that would effectively eliminate the OFCCP, this moratorium extension likely reflects the need to address the previous May 2025 expiration date, rather than an indication that the agency is ramping up its activities.
This extension represents the latest in a series of actions dating back to 2014, when the OFCCP first limited its enforcement activities for TRICARE subcontractors in an effort to balance regulatory requirements and veterans’ access to healthcare, allowing for more time to consider stakeholder feedback. The moratorium was later expanded to include VAHBP providers. Effective August 31 2020, OFCCP’s final rule established that it does not have authority over TRICARE providers. The current moratorium extension provides additional time for the OFCCP to develop sub-regulatory guidance specifically addressing VAHBP providers.
While the extension offers some regulatory relief, VAHBP providers must remain aware that the moratorium does not exempt them from nondiscrimination obligations.
Congressional Budget Proposal Includes Adjustments to Dual-Eligible Enrollment Pathways and Medicare Savings Program Rules
In June 2025, the U.S. House of Representatives introduced a budget reconciliation bill titled the One Big Beautiful Bill Act (OBBBA). The legislation proposes a number of administrative changes to existing federal health programs, including modifications to automatic enrollment procedures affecting individuals who qualify for both Medicare and Medicaid. The bill does not repeal current benefit programs but includes provisions that would revise the process through which certain low-income individuals access premium and cost-sharing assistance programs.
Individuals who are eligible for both Medicare and Medicaid, commonly referred to as dual-eligible beneficiaries, accounted for approximately 14 percent of the Medicare population in 2021 and represented about 30 percent of Medicare fee-for-service spending, according to the Medicare Payment Advisory Commission. One program that serves this population is the Low-Income Subsidy (LIS), also known as “Extra Help,” which assists with Medicare Part D prescription drug premiums and other related out-of-pocket costs. The Centers for Medicare & Medicaid Services has estimated that the average annual value of this benefit is approximately $6,200 per beneficiary.
Under current law, individuals who are enrolled in Medicaid and subsequently become eligible for Medicare are automatically enrolled in LIS. The OBBBA proposes to eliminate automatic LIS enrollment for individuals who lose Medicaid eligibility. According to the Congressional Budget Office, which is a nonpartisan legislative agency, approximately 1.38 million individuals who are dually eligible for Medicare and Medicaid may lose their Medicaid coverage between 2025 and 2034. As a result, those individuals would no longer be automatically enrolled in LIS and would instead need to apply for the benefit directly through the Social Security Administration.
The OBBBA also includes provisions to delay implementation of certain federal regulations related to the Medicare Savings Programs, which help low-income individuals pay for Medicare Part B premiums and, in some cases, additional cost-sharing obligations. These regulations were finalized by the Centers for Medicare & Medicaid Services in 2023 and 2024 and were designed to streamline enrollment processes by reducing paperwork and simplifying eligibility verification. CMS previously estimated that these regulatory changes would result in approximately 860,000 new enrollees in the Medicare Savings Programs. The legislation proposes to delay the implementation of these provisions from 2027 to 2035.
The Congressional Budget Office projects that this delay would result in a reduction of federal Medicaid expenditures by approximately $162 billion over ten years. It also estimates that the change would lead to approximately 2.3 million fewer Medicaid enrollees during that period, of whom approximately 60 percent would be dual-eligible beneficiaries.
For individuals affected by these changes, the loss of Medicaid coverage would require separate applications to maintain access to both LIS and Medicare Savings Programs. LIS applications must be submitted to the Social Security Administration, while applications for Medicare Savings Programs are processed by individual state Medicaid agencies. These processes generally require income and, in some cases, asset verification. In addition to overseeing eligibility determinations, state Medicaid agencies would remain responsible for ensuring compliance with federal due process requirements, including adequate notice and appeal rights. Agencies would also need to confirm that enrollment procedures align with applicable civil rights and nondiscrimination laws.
The proposed legislation is currently under congressional consideration and may be amended prior to enactment. Stakeholders such as state Medicaid agencies, Medicare Advantage plans, healthcare providers, and beneficiary support organizations may wish to monitor further developments to assess potential operational and compliance implications. The changes outlined in the bill focus on administrative processes and eligibility pathways and do not modify the statutory structure of Medicare or Medicaid benefit categories.
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Five Things Every Health Care Provider Should Know About HHS OIG’s 2025 Semiannual Report
On June 2, 2025, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) published its Semiannual Report to Congress. This report covers the period from October 1, 2024, through March 31, 2025, and highlights the OIG’s key findings and recommendations for the reporting period.
Below are the five critical insights every health care provider should be aware of from the report.
1. Monetary Impact: OIG reported $16.61 billion in total for their work’s monetary impact, including $3.51 billion of the total from investigative receivables, which is money ordered or agreed to be returned to HHS or other governmental entities based on OIG investigations. The findings are evidence of OIG’s active enforcement during the reporting period.
2. Enforcement Actions and Exclusions: The OIG initiated a total of 744 enforcement actions, with a nearly equal distribution between criminal (349) and civil (395) actions. Additionally, over 1,500 individuals were added to the OIG exclusion list, rendering them ineligible to participate in federally funded health care programs. These findings highlight the OIG’s commitment to pursuing criminal and civil resolution of health care matters as well as health care program exclusions.
3. Medicare Advantage Program Oversight: The OIG identified significant issues within the Medicare Advantage risk adjustment program, including $13.6 million in net overpayments to three Medicare Advantage plans due to incorrect diagnosis coding. The evaluation revealed that in-home health risk assessments (HRAs) linked chart reviews generated $4.2 billion of the $7.5 billion in risk-adjustment payments. Consequently, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) impose additional restrictions on the use of diagnoses reported solely in in-home HRAs, indicating this area will likely be a focus of future OIG compliance monitoring.
4. Improper Payments: OIG found that CMS “made millions of dollars” in improper drug payments, resulting in unnecessary costs to the federal government and taxpayers. According to its report, this included $465 million for drugs covered under Medicare Part A but paid under Part D, $454 million for COVID-19 tests exceeding the monthly limit, and $190 million for outpatient services that were already covered. Given the impact of these payments, claims submitted for these services will likely face higher scrutiny from OIG and CMS in the future.
5. Fraud, Waste and Abuse: OIG evaluated and processed almost 31,000 tips that led to 17,000 referrals including to the Department of Justice and other agencies. During the review period, hotline complaints resulted in expected recoveries totaling $121 million according to the report.
The report demonstrates the OIG’s prioritization of effort to investigate fraud, waste and abuse allegations, and its willingness to seek both civil and criminal resolutions as well as federal health care program exclusion when appropriate. Importantly, the report provides insight into the OIG’s priorities and potential areas for future enforcement.
Supreme Court Nixes Retiree’s ADA Benefits Suit
In Stanley v. City of Sanford, Florida, the U.S. Supreme Court held a disabled former employee who neither “holds” nor “desires” a job is not a “qualified individual” under the ADA and, thus, cannot sue for disability discrimination following her employer’s revocation of retiree health benefits.
The plaintiff, Karyn Stanley, was a firefighter for the City of Sanford, Florida (“City”) who retired after she was diagnosed with Parkinson’s disease. When she joined the fire department, disabled retirees received free health insurance until they were 65 years old. While employed and unbeknownst to her, the benefit changed and disabled retirees were eligible for two years of coverage. Following her retirement, the plaintiff learned of the benefit change and received the two years of health insurance coverage.
Stanley, post-retirement, filed a lawsuit against the City alleging that the City violated the ADA and discriminated against her as a disabled retiree when it altered the health insurance plan. The district court dismissed her ADA claim. On appeal, the Eleventh Circuit affirmed, holding that, because Stanley had retired, she could not bring such a suit under the plain language of the statute. The Eleventh Circuit’s decision fell in line with three other circuits (Sixth, Seventh, and Ninth), while two other circuits (Second and Third) held that the ADA’s text is ambiguous and construed the statute in favor of employees.
The Court granted certiorari to determine “whether a retired employee who does not hold or seek a job is a ‘qualified individual.’” In a 7-2 opinion authored by Justice Gorsuch, the Court held that the plain language of the statute protects only “qualified individuals,” which is defined by the statute as those “who, with or without reasonable accommodation, can perform the essential functions of the employment position that [she] holds or desires.” The Court found that the present tense usage of “holds” and “desires” signals that the statute does not reach retirees. The Court found that other ADA provisions governing qualification standards and employment tests similarly convey that the statute “focus [is] on current and prospective employees—not retirees.” The Court also found it notable that the ADA’s retaliation provision protects “any individual,” and thus “different language in these two provisions strongly suggests that [Congress] meant for them to work differently.”
Rejecting arguments from the dissent that the “qualified individual” language could not have been meant to apply to retirees, the majority held that “we do not usually pick a conceivable-but-convoluted interpretation over the ordinary one.” The Court added: “we cannot say Title I’s textual limitations necessarily clash with the ADA’s broader purposes . . . . If Congress wishes to extend Title I to reach retirees like Ms. Stanley, it can.”
The last section of Gorsuch’s opinion was adopted by a four-justice plurality of the Court in which Gorsuch lost support from Justices Roberts, Thomas, Kavanaugh, and Barrett, but added support from dissenting Justice Sotomayor. The plurality addressed an additional question raised by Stanley in her merits briefing. While the Court admitted that it “ordinarily . . . rejects attempts to inject ‘an entirely new question at the merits stage,’” the plurality made “an exception in this case.” In short, the plurality explored potential avenues for retirees, like Stanley, to pursue similar ADA claims, but ultimately held that none provided relief to Stanley in the present procedural posture.
A key takeaway from Stanley is that a majority of the Court supports a textualist interpretation of the ADA even when an argument can be made that such an interpretation clashes with the broader purposes of the ADA.
OIG Says Medical Device Company’s Proposal to Pay for Exclusion Screening for Customers May Violate the Anti-Kickback Statute
On June 20, 2025, the Department of Health and Human Services’ Office of Inspector General (“OIG”) issued an unfavorable advisory opinion – OIG Advisory Opinion 25-04 (“AO 25-04”).
AO 25-04 discusses a proposal by a medical device company (the “Requestor”) to cover the costs for its customers—hospitals, health systems, and ambulatory surgery centers—to have a third-party company screen and monitor the Requestor for exclusion from federal healthcare programs. The OIG concluded that the proposed arrangement would potentially generate prohibited remuneration under the federal Anti-Kickback Statute (“AKS”).
According to the advisory opinion, some of the Requestor’s customers were either requesting or requiring, as a condition of doing business, that the Requestor pay a third-party company (the “Company”) to screen and monitor them for exclusion from federal healthcare programs. Under the proposed arrangement, the Company would charge the Requestor (and not its customers) an annual subscription fee for each customer receiving these screening and monitoring reports. The Requestor estimated this would amount to approximately $450,000 in annual fees, paid directly to the Company. The Requestor would not be a party to any agreements between its customers and the Company.
In reviewing the proposed arrangement in AO 25-04, the OIG determined that the Requestor’s proposed payment of the exclusion screening fees on behalf of its customers would implicate the AKS because the Requestor would be paying for the costs associated with a service—exclusion screening and monitoring—that its customers would otherwise incur. This payment constitutes remuneration to those customers. The OIG explained that by relieving customers of this financial burden, the proposed arrangement could induce them to purchase items or services from the Requestor that are reimbursable by a federal healthcare program. According to the OIG, the proposed arrangement “presents anti-competitive risks and risks of inappropriate steering.” Specifically, the OIG noted concern that paying the fees on a per-customer basis could improperly sway customers toward the Requestor, especially over competitors unwilling or unable to offer similar payments. In support of the unfavorable decision, the advisory opinion notes the OIG’s “longstanding and continuing concerns” about the provision of free items or services by individuals and entities, including device manufacturers, to referral sources.
While the OIG noted that a different fact pattern or structure to the arrangement might have resulted in a favorable opinion, here, with these facts – including the per-customer fee structure, the OIG cited its concern about the potential for the Company to act as a “gatekeeper” of referrals. Because customers have conditioned their business on the Requestor’s payment of the Company’s fees for exclusion screening and monitoring, the OIG noted the risk that the Requestor would pay the fees to gain access to those referrals.
We typically see hospitals and health systems as the entities performing the exclusion screening of potential vendors before entering into a contract with a vendor. In the proposed arrangement in AO 25-04, the script is flipped, with customers (i.e., hospitals, health systems, and ASCs) requiring that the medical device company from which they’re proposing to purchase items engage a third party to screen and monitor the medical device company for potential exclusion and submit reports to those customers regarding the results of such screening and monitoring.
While the OIG concedes in a footnote to AO 25-04 that there is no statutory or regulatory requirement to perform exclusion screening, the OIG’s position is that screening employees and contractors each month best minimizes potential overpayment and civil monetary penalty (“CMP”) liability. Historically, the OIG has cautioned against relying on a third party to determine whether an individual or entity is excluded and warned that a healthcare provider may still be responsible for overpayments and CMPs relating to items or services that have been ordered, prescribed, or furnished by excluded individuals or entities. However, the OIG also noted in the 2013 Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs that a healthcare provider may be able to “reduce or eliminate its CMP liability” in such situations if the healthcare provider “is able to demonstrate that it reasonably relied on the [other entity] to perform a check of the [OIG’s List of Excluded Individuals and Entities (“LEIE”)] and “exercised due diligence in ensuring that the [other entity] was meeting its contractual obligation.” One can only assume that it was the fact that customers were conditioning business on the medical device company paying the Company on a per-customer basis to do the exclusion screening and monitoring that tipped the scale to an unfavorable opinion here.
This advisory opinion serves as a reminder that any arrangement where a provider or supplier pays for services or costs that would otherwise be the responsibility of a referral source requires scrutiny under the AKS. If one purpose of the payment is to induce referrals or purchases of items and services reimbursable by federal healthcare programs, the arrangement may violate the AKS.
Reminder: California Healthcare Minimum Wage Increase Effective July 1, 2025
Employers in the healthcare industry in California are subject to a separate minimum wage from other employers.
Effective July 1, 2025, certain healthcare facilities will see an increase in their minimum wage rates. The following is a summary of the increases based on the type of employer.
Type of Healthcare Employer
Current Rate
Increased Rate
Hospitals or Integrated Health Systems with 10,000 or more full-time employees, including skilled nursing facilities operated by these employers
$23
$24
Dialysis Clinics
$23
$24
Covered Health Care Facilities run by large counties with more than five million people as of January 1, 2023
$23
$24
Hospitals with 90% or more of their patients paid for by Medicare or Medi-Cal
$18
$18.63
Independent Hospitals with 75% or more of their patients paid for by Medicare or Medi-Cal
$18
$18.63
Rural Independent Covered Health Care Facilities
$18
$18.63
Covered Health Care Facilities run by small counties with fewer than 250,000 people
$18
$18.63
While several categories of healthcare employees will receive a minimum wage increase in July 2025. The following categories of healthcare employers will not have a minimum wage increase until July 2026:
Intermittent clinics, community clinics, rural health clinics, or urgent care clinics associated with community or rural health clinics
Covered Health Care Facilities run by Medium Sized Counties (250,000 to five million people as of 1/1/23)
Skilled Nursing facilities not owned, operated, or controlled by a hospital, integrated health care delivery system, or health care system
All other covered health care facilities not listed in the other categories and not run by Counties
Who is Covered?
The definition of “health care employee” is broad, encompassing a wide range of roles within healthcare facilities. This includes employees who provide patient care, health care services, or services supporting the provision of health care. Examples of covered roles include:
Nurses
Physicians
Caregivers
Medical residents, interns, or fellows
Patient care technicians
Janitors
Housekeeping staff
Groundskeepers
Guards
Clerical workers
Non-managerial administrative workers
Food service workers
Gift shop workers
Technical and ancillary services workers
Medical coding and billing personnel
Schedulers
Call center and warehouse workers
Laundry workers.
Healthcare Preview for the Week of: June 23, 2025 [Podcast]
Reconciliation Byrd Rulings and Potential Floor Vote
This week will be busy as Republicans race to try to get the reconciliation package to President Trump’s desk by July 4. Last week, the Senate Finance Committee, which has jurisdiction over the most provisions of the package, including Medicaid, the Affordable Care Act, and taxes, released its version of text. The Finance Committee made substantive changes to key House-passed Medicaid and tax policies and has been met with criticism by multiple Republican Senators, such as Sen. Hawley (R-MO), along with moderate House Republicans who oppose certain tax policy changes.
Senate and House passage will be an uphill battle, but the current package is already changing as negotiations for votes and the Byrd rule process continue. Due to concerns over the Medicaid provider tax policy modified by the Senate, Senate Republicans are floating the idea of adding a rural hospital fund to help those hospitals financially and try to then win the support of concerned senators. Other policies put forth in the Senate Finance package may have been placeholders to gauge support and may continue to change as well.
The Senate parliamentarian has already ruled that certain provisions, including some related to the Supplemental Nutrition Assistance Program, do not comply with the Byrd rule and must be struck to allow for Senate passage by a simple majority. Some of the struck provisions were major savers and could cause Republicans to add or modify policies to fill those gaps. We also await a Congressional Budget Office (CBO) score of the Senate bill. The parliamentarian is expected to rule on health provisions as early as Monday. It is anticipated that the Senate will release an updated package after the Byrd process concludes and before a Senate floor vote, scheduled for later this week. That vote could get pushed back if there is continued opposition from more than three Republican senators, since that is the most they can lose on the floor vote. If the Senate vote is pushed back, the timeline of getting the bill to President Trump by July 4 could also get pushed back, as the House needs to pass the Senate-passed bill as well. As of now, both chambers are scheduled to be out of session next week.
Amid all this Senate action, the House will consider several health bills on the floor under suspension of the rules today. They include H.R. 1082, the Shandra Eisenga Human Cell and Tissue Product Safety Act, which would require HHS to increase awareness of the potential risks and benefits of human cell and tissue transplants, and H.R. 1520, the Charlotte Woodward Organ Transplant Discrimination Prevention Act, which would prohibit providers from denying an organ transplant based solely on an individual’s disability. Both bills passed out of the Energy and Commerce Committee earlier this year with bipartisan support.
There will also be action at the committee level this week, with significant House and Senate hearings. The Senate Health, Education, Labor, and Pensions Committee will consider the nomination of Susan Monarez, PhD to be Centers for Disease Control and Prevention (CDC) director. She is currently acting CDC director and was nominated to officially serve as director after the White House abruptly withdrew the nomination of former Representative Dave Weldon, MD. US Department of Health and Human Services (HHS) Secretary Kennedy will testify at the House Energy and Commerce Committee on the fiscal year (FY) 2026 budget request, where attention will likely also focus on how the agency is or is not spending FY 2025 appropriated funds and on vaccine policy.
Today’s Podcast
In this week’s Healthcare Preview, Debbie Curtis and Rodney Whitlock join Julia Grabo to discuss where the Senate is on reconciliation ahead of the quickly approaching, self-imposed July 4th deadline.
Fifth Circuit Rules No Private Right of Action Under No Surprises Act
The Fifth Circuit Court of Appeals issued an opinion concluding the No Surprises Act does not give providers a private right of action to enforce and recover from dispute resolution rewards.
The Court held that unlike the Federal Arbitration Act, the No Surprises Act lacks language authorizing judicial enforcement of IDR decisions, so plaintiffs cannot sue under it.
The decision comes as federal district courts remain divided on the issue, adding to the ongoing uncertainty surrounding the implementation of the No Surprises Act.
This decision emphasizes the importance of strategic contract drafting, which may provide independent private causes of action.
In a significant ruling for healthcare providers, the Fifth Circuit Court of Appeals held that two air ambulatory service providers cannot sue to enforce payment of Independent Dispute Resolution (IDR) awards issued under the No Surprises Act. In its June 13 ruling, the Court affirmed the Texas District Court’s previous dismissal, finding that the No Surprises Act does not contain a private right of action allowing providers to enforce such awards directly in federal court.
Background
The No Surprises Act is a U.S. law designed to protect patients from unexpected medical bills. Since coming into effect in January 2022, the law relieves patients from financial liability for so-called “surprise bills”— bills from patients unknowingly receiving care from out-of-network providers, usually in emergency situations or at in-network facilities — and created an IDR-driven framework for billing disputes between providers and insurers.
Under this framework, providers and insurers must first attempt negotiations on the service price. If negotiations fail, either party may initiate the IDR process and select a certified independent resolution entity (CIDRE) to referee further negotiations and determine the amount the insurer owes the provider.
Here, the providers-initiated IDR to resolve their billing dispute with the insurer, and the CIDRE determined the payment award amount the insurer owed the providers. After IDR concluded, the providers sued the insurer, alleging the insurer violated the No Surprise Act by failing to timely pay the IDR award amount to the providers. The providers also alleged causes of action under ERISA and unjust enrichment.
Decision
The Fifth Circuit Court of Appeals reasoned that the providers failed to carry the burden of showing Congress contemplated a private right of action in the No Surprises Act. Instead, Congress intentionally vested the U.S. Department of Health and Human Services (HHS) with the relevant enforcement authority, including the ability to impose administrative penalties on noncompliant insurers that fail to pay providers awarded sums. The panel determined judicial review of IDR awards is limited under the statute to certain provisions of the Federal Arbitration Act (FAA). However, the providers conceded the FAA provisions were inapplicable in this case. The Court rejected the providers’ argument that they were seeking “enforcement” rather than “review” of the awards, calling it a “distinction without a difference,” as judicial review includes actions that seek to confirm or enforce a dispute resolution award.
The Court also dismissed the providers’ ERISA claim for a lack of standing. Although the providers claimed to have been standing through beneficiary assignments, the panel found that the beneficiaries suffered no injury because the No Surprises Act shields them from financial responsibility for out-of-network charges. The unjust enrichment claim failed as well, as the Court found no direct benefit conferred on the insurer. This ruling adds to a growing national divide on No Surprises Act enforcement mechanisms, including for IDR awards.
Key Takeaways
While the Fifth Circuit has now definitively rejected a private right of action under the No Surprises Act, the U.S. District Court for the District of Connecticut recently reached the opposite conclusion, holding that providers can bring suit to enforce IDR awards and assert ERISA claims in that context. That split may ultimately require a resolution by the Supreme Court or further legislative clarification.
Until the circuit split is resolved, providers operating in the Fifth Circuit’s jurisdiction (Louisiana, Mississippi and Texas) must rely on HHS enforcement mechanisms, rather than the courts, to secure payment on IDR awards. This decision underscores the importance of strategic contract drafting and proactive claims management, as providers may have limited legal remedies once the IDR process concludes.
Texas Noncompete Shakeup: New Frontier for Health Care Practitioners
Sweeping changes to noncompete covenants are set to take effect on September 1, 2025, for health care employers in Texas. These changes stem from recent amendments to Texas’ noncompete statute. These changes will:
Expand Texas’ heightened enforceability requirements to nearly all health care practitioners.
Impose strict limits on the duration and geographic area of applicable noncompete covenants.
Cap the buyout option that must be provided to covered health care practitioners.
Who Is Impacted?
The recent amendments to Texas’ noncompete statute were enacted through Texas Senate Bill 1318 (SB 1318) that was signed into law by Governor Abbott on June 20, 2025. It will impact Texas-licensed physicians, dentists, nurses (including advanced practice nurses), physician assistants, and health care entities that execute noncompete covenants with the aforementioned health care practitioners. Downstream, these amendments have the potential to alter various health care business models, and the value assigned to health care entities in mergers and acquisitions.
What Are the Key Changes?
Since 1999, the Texas noncompete statute has imposed heightened requirements for securing enforceable covenants with physicians licensed by the Texas Medical Board. SB 1318 takes these protections a step further by incorporating the following heightened requirements:
Mandatory/Salary-Capped Buyout Options – Similar to physicians, mandatory buyout clauses must now be integrated into noncompete covenants with dentists, nurses and physician assistants. The amendments eliminate the statute’s open-ended “reasonable price” requirement and will now require buyout clauses to not exceed a covered individual’s “total annual salary and wages at the time of termination.” For many agreements, this will result in a significant reduction from previous buyout clauses.
One-Year Duration – Noncompete covenants that are executed with physicians and other health care practitioners will be limited to one (1) year following the termination of the covered individual’s contract or employment.
Five-Mile Radius – The geographic area of noncompete covenants that are executed with physicians and other health care practitioners will now be limited to “a five-mile radius from the location at which the health care practitioner primarily practiced before the contract or employment terminated.”
Termination Without “Good Cause” for Physicians – The circumstances of a physician’s termination will impact the enforceability of their noncompete covenant. Noncompete covenants will be void and unenforceable against a physician if they are involuntarily terminated without “good cause,” which is defined as “a reasonable basis for discharge . . . that is directly related to the physician’s conduct, including the physician’s conduct on the job, job performance and contract or employment record.” Importantly, this distinction is limited to physicians. The enforceability of noncompete covenants that are executed with other health care providers will not be impacted by the circumstances of their termination.
Clear and Conspicuous Language – Noncompete covenants that are executed with physicians and other health care practitioners must now “have terms and conditions clearly and conspicuously stated in writing.” SB 1318 does not expand further on this requirement, but it will result in noncompete covenants being susceptible to attack on this basis.
Managerial/Administrative Carve-Out – Before the enactment of SB 1318, Texas’ heightened enforceability requirements extended to most physician-entered noncompete covenants “related to the practice of medicine” (excluding certain business ownership interests). This created some ambiguity regarding when these heightened requirements were triggered. SB 1318 partially resolves this by emphasizing “the practice of medicine does not include managing or directing medical services in an administrative capacity for a medical practice or other health care provider.” Stated differently, noncompete covenants that are executed with physicians employed solely in a managerial or administrative capacity will not be subject to these heighted requirements.
When Do These Changes Go into Effect?
The changes go into effect on September 1, 2025. Importantly, these changes are prospective in nature and only apply to noncompete covenants that are entered into or renewed on or after this date—meaning that preexisting noncompete covenants will continue to be governed by Texas’ noncompete laws existing before the effective date of SB 1318.
What’s Next?
These amendments are consistent with the nationwide trend towards more restrictions on the permissive use of noncompete covenants. While these amendments are not retroactive, it is conceivable that judges may still take these amendments into consideration when analyzing the enforceability of preexisting covenants in future litigation under Texas’ current “no greater than necessary” standard. In turn, employers will need to weigh whether they make these changes on a rolling basis or preemptively amend existing agreements and consider other avenues for protection.
Maine and Oregon Join List of States Prohibiting the Reporting of Medical Debt on Consumer Reports
In June, Maine and Oregon joined a growing list of states that now prohibit the reporting of medical debt to a consumer reporting agency.
On June 9, 2025, the governor of Maine signed into law LD558, which amends the Maine Fair Credit Reporting Act to prohibit medical creditors, debt collectors and debt buyers from reporting a consumer’s medical debt to a consumer reporting agency. Under the Maine law, a “medical creditor” is defined as “an entity that provides health care services and to whom a consumer incurs medical debt or an entity that provided health care services to a consumer and to whom the consumer previously owed medical debt if the medical debt has been purchased by one or more debt buyers.” Additionally, the Maine law forbids consumer reporting agencies from reporting medical debt on consumer reports. Consumers whose medical debt is reported in violation of the new amendments can seek civil remedies against the medical creditor, debt collector, debt buyer, or consumer reporting agency that reported the medical debt pursuant to the Maine Fair Credit Reporting Act for actual damages, attorneys’ fees and costs, and either treble damages or statutory damages depending on whether the violation was willful or negligent.
On June 17, 2025, the governor of Oregon signed into law SB0605, amending current Oregon statute 646A.677 to ban the reporting of medical debt owed by Oregon residents to any consumer reporting agency. The Oregon law is more expansive than the new Maine law in that it prohibits any “person” from “report[ing] to a consumer reporting agency the amount or existence of any medical debt” that a resident of Oregon “owes or is alleged to owe.” The law applies to medical debt that is owed to health care providers, as well as owed to credit cards issued for the purpose of covering medical expenses. The new law also states that consumer reporting agencies “may not include in a consumer report an item that the consumer reporting agency knows or reasonably should know is medical debt.”
The new Oregon law allows individuals to bring a private civil action pursuant to Oregon’s Unlawful Trade Practices Act against any violator of the statute. In a civil action, “in addition to any other relief a court may grant, the court may declare the medical debt void and uncollectible.”
Maine and Oregon join New York, California, Illinois, New Jersey, Minnesota, Virginia, Colorado, Rhode Island, and Vermont in enacting laws that prohibit or restrict what information regarding medical debt, if any, can be reported to consumer reporting agencies. The increase in states enacting consumer protection laws targeting medical debt is unsurprising in light of the Consumer Financial Protection Bureau’s (“CFPB”) failure to implement a federal rule on this topic.
As previously reported, in January 2025, the CFPB passed a federal rule banning the reporting of individuals’ medical debt on consumer credit reports that was set to become effective in March 2025. The CFPB, however, pursuant to a January 20, 2025 Executive Order, adjourned the implementation of the rule. Recently, the CFPB sided with creditor industry groups that filed lawsuits to halt the federal rule and asked a federal court to allow it to withdraw the federal rule banning reporting of consumer medical debt.
Health care providers delivering services to residents of Maine or Oregon, as well as debt collectors and debt buyers that perform services in these states, should ensure that their current policies regarding the reporting of consumer medical debt align with the new laws. Given the increasing number of jurisdictions enacting laws that ban the reporting of consumer medical debt and the potential for some of those laws to prevent the collection of consumer medical debts that are reported to a consumer reporting agency and/or expose the reporter of the medical debt to civil litigation and a potential monetary judgment against it, entities providing health care services and/or engaging in the collection of consumer medical debt need to remain abreast of the consumer protection laws in the states in which they provide services and adjust their practices accordingly.
Managing the “Infinite Workday”: Employer Responsibilities in a 24/7 Work Culture
Remember when the workday ended at 5:00 pm?
In today’s always-on world, the “infinite workday” has quietly taken over—creeping into dinners, weekends, and even that quaint concept known as a “vacation.” With smartphones in every pocket and teams spread across multiple time zones, work now follows us everywhere. Microsoft’s 2025 Work Trend Index confirms what many leaders already sense: work is no longer confined by time or place—it’s always on.
The data is striking. By 6:00 a.m., 40% of workers are already checking email. During core hours, employees are interrupted every two minutes by meetings, messages, and alerts. And the day doesn’t end at dinner—nearly a third of workers are back in their inboxes by 10:00 p.m. Weekend work is also on the rise with nearly 20% of employees checking email before noon on Saturdays and Sundays. While the flexibility to work anytime, anywhere can be empowering, it also brings legal, operational, and cultural challenges that employers ignore at their peril.
The Rise of the “Right to Disconnect”
The infinite workday isn’t just stretching schedules – it’s stretching people thin. Microsoft’s data shows that one in three employees say the pace of work has made it impossible to keep up. Half of employees and leaders describe their work as chaotic and fragmented.
A major driver of this strain is the overwhelming volume of digital communication. According to the Index, on average, employees receive more than 100 emails and 150 Teams messages every workday. In fact, some exasperated workers have declared “email bankruptcy” – deleting their entire inbox of unanswered emails in an effort to regain control. It’s a clear sign that employees are struggling to keep up with the volume and velocity of communication.
In response, governments around the world are stepping in with “right to disconnect” laws – designed to protect employees from the expectation of 24/7 availability. Countries including Argentina, Australia, Belgium, Chile, France, Slovenia, and Spain have enacted laws limiting after-hours communications. Our neighbors in Ontario, Canada mandate written disconnect-from-work policies for employers with 25+ employees.
While the U.S. has no such law yet, the conversation is gaining traction. As we reported last year, California proposed but ultimately did not enact a right-to-disconnect law in 2024, and New Jersey introduced similar legislation that remains under review.
Legal Risks for Employers
Even in the absence of formal legislation, the risks of an always-on culture are real and growing:
Wage and Hour Violations. Non-exempt (“hourly”) employees working off the clock – even voluntarily—can trigger wage claims, class actions, and penalties under the Fair Labor Standards Act and comparable state laws.
Mental Health and Burnout. Constant connectivity can lead to stress-related claims under the Americans with Disabilities Act, Family Medical Leave Act, and comparable state laws as well as workers’ compensation rules.
Data Privacy and Security. After-hours work on personal or unsecured devices increases the risk of data breaches and non-compliance with laws such as the California Privacy Rights Act and the European Union’s General Data Protection Regulation.
Discrimination and Equity Concerns. An always-on culture may disproportionately impact caregivers, parents, and employees in different time zones—raising potential claims of disparate impact or failure to accommodate.
Best Practices
To stay ahead of legal and cultural shifts, employers should consider the following steps:
Establish Clear Boundaries. Define expectations for work hours and after-hours communication in policies and handbooks, especially for non-exempt employees.
Train Managers. Educate leaders on the legal risks and model healthy behavior around availability and responsiveness.
Audit Timekeeping Systems. Ensure all work—especially by non-exempt employees— is accurately tracked and compensated.
Encourage Disconnecting. Promote a culture that values rest and recovery, and discourage after-hours messages unless truly necessary.
Final Thoughts
The infinite workday is here—but it doesn’t have to mean infinite liability. By understanding the evolving legal landscape and implementing thoughtful, proactive polices, employers can protect both their workforce and their business.