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DOJ and States Challenge Health Insurer Mergers

Following more than a year of regulatory review, in late July 2016 the Department of Justice (DOJ) Antitrust Division and a number of states filed actions seeking to derail both the Anthem/Cigna and Aetna/Humana mergers. In...more

Finally A Clear Ruling On A Much Needed Bankruptcy Preference Defense

The United States Bankruptcy Court for the District of Delaware has finally clarified that the administrative expense claim for goods delivered post-bankruptcy filing may be set off – dollar for dollar – to reduce any open...more

Healthcare Newsletter: Volume 6, Number 1

Recent Developments in Mental Health Benefit Denials - The Mental Health Parity and Addiction Equity Act (Parity Act) requires health plans to provide the same coverage for mental health conditions as they provide for...more

DOJ Seeks to Block Two Major Health Insurance Mergers

The United States Department of Justice (DOJ) is suing to block two proposed mergers between major health insurance companies, claiming that the deals violate antitrust laws and would lead to increased health care costs for...more

Health Insurer Mergers Draw Regulatory Opposition

In July 2015, Aetna announced its intention to acquire Humana, followed later that month by Anthem's announcement that it was acquiring Cigna. The deals are the largest insurance mergers ever proposed, and if consummated,...more

Manatt on Health Reform: Weekly Highlights - June 2016#2

Arkansas’ Governor requests to transition to a “State-based Marketplace on the Federal Platform;” Louisiana launches Medicaid expansion with SNAP fast-track enrollment; and study shows 2016 premium increases are lower for...more

Monday Briefing

Here’s your short-form Monday Briefing for the first week of October....more

Kentucky Federal Court Sustains Hospital Insurer’s Denial of Claim Due to Untimely Notice, Declines to Require Insurer Show...

The U.S. District Court for the Eastern District of Kentucky recently held that an insurer properly denied coverage to a hospital because the hospital gave untimely notice of the claim. In Ashland Hospital Corporation v. RLI...more

Late Notice of Claim Costs Kentucky Hospital $10 Million

A federal court in Kentucky ruled on March 17 that Ashland Hospital had forfeited $10 million of insurance coverage because it was late in notifying its insurance company of the claim....more

Health Headlines: Also in the News - October 2014 #4

New Guidelines Released Concerning Treatment of Ebola Patients – In response to increasing concerns about the risk posed by Ebola to healthcare professionals, the Centers for Disease Control and Prevention (CDC) released new...more

The Future of Premium Subsidies under the Affordable Care Act: 'Halbig v. Burwell' and 'King v. Burwell'

Both decisions addressed whether tax credits are available for residents in states that have federally-facilitated health exchanges. The District of Columbia Court of Appeals said “no”; the Fourth Circuit Court of Appeals...more

How Big Is Halbig? The Viability of the ACA’s Employer Mandate Hangs in the Balance

For employers with employees in the 36 states with a federally facilitated exchange, the question arises how the Halbig decision impacts their decision and strategy to provide health coverage to their employees when the...more

Evaluating Employer Insurance Coverages to Defend against Claimed Violations of the Affordable Care Act

Employers have long been subject to lawsuits brought by employees for employment actions such as wrongful termination, discrimination and harassment. With the opening this week of the Health Insurance Marketplaces and the...more

The Affordable Care Act & the Impact on the C-Suite – Interview with Alden Bianchi, Member, Mintz Levin [Video]

Attorney Alden Bianchi, Practice Group Leader of Mintz Levin's Employee Benefits & Executive Compensation Practice, discusses why the Affordable Care Act makes health care benefits something that should be top-of-mind to...more

The Affordable Care Act: The Structure of Health Plans – Interview with Alden Bianchi, Member, Mintz Levin  [Video]

Attorney Alden Bianchi, Practice Group Leader of Mintz Levin's Employee Benefits & Executive Compensation Practice, discusses how health plans will be purchased under PPACA....more

First Year Analysis – The Pioneer ACO Program Wins Some, Loses Some

This week, CMS announced the shared savings results and the clinical achievements from the first year of the Pioneer ACO Program. During the first year...more

Provisions of Affordable Care Act Could Impact Tax-Exempt Status of Certain Bonds

Certain payment models created under the Patient Protection and Affordable Care Act intended to coordinate care and lower healthcare costs raise questions concerning the tax-exempt status of debt issued by certain healthcare...more

Shorts on Long Term Care - June 2013

In this issue: - What’s Up With Nursing Facility “Mandatory” Corporate Compliance Programs? - Updated OIG Exclusion Guidance Spells Out Recommended Employee Screening Procedures - General Assembly Calls...more

Affiliates of Health Insurance Providers May Be Subject to the Affordable Care Act $500,000 Deduction Limit on Executive...

Most issuers of healthcare insurance likely have heard about the $500,000 limit on deductible compensation that became effective January 1, 2013, but might be surprised to know how much broader the scope of the deduction is...more

CMS Announces Additional Open Period for Bundling Model 1

On Friday, May 17, 2013, CMS announced that its Center for Medicare and Medicaid Innovation Center (Innovation Center) is providing an open period for additional organizations to be considered for participation in Model 1 of...more

NOIs Due Soon to Apply for 2014 ACO Program

The Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) established under the Affordable Care Act is about to kick-off its second year with a new round of applications for the January 1, 2014...more

Who is a Large Employer Under Obamacare?

Among other things, the Patient Protection and Affordable Care Act (the “Act”), commonly referred to as Obamacare, requires “large employers” to provide qualified health coverage for all of their full-time employees, or pay...more

New Guidance for Tax-Exempt Hospitals on Community Health Needs Assessment and Other Section 501(r) Requirements

On April 5, the Treasury Department released proposed regulations that provide guidance on the community health needs assessment (“CHNA”) and other requirements for tax-exempt hospitals under section 501(r) of the Internal...more

Physician Payment Sunshine Act Final Rule Released

In This Issue: - Interpretation and Clarification of Key Definitions ..Applicable Manufacturers ..Applicable GPOs ..Covered Drug, Device, Biological or Medical Supply ..Covered Recipients ...more

Hot Fraud and Abuse Issues for Ambulatory Surgery Centers: An Advanced Interactive Discussion

In This Presentation: • How To Redeem Physician Owners, And Under What Terms? • How To Minimize Legal/Regulatory Risk When All “Safe Harbor” Requirements Are Not Being Followed? • Structuring Anesthesia Arrangements...more

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