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Reducing the Regulatory Stranglehold on Federally Facilitated Exchanges: Will It Work?

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule aimed at improving the individual and small group markets that have been plagued with instability as issuers continue exiting the Exchanges....more

DOJ Successfully Blocks Insurance Mergers: What Are the Takeaways?

In July 2016, following a lengthy review, the Antitrust Division of the Department of Justice (DOJ), together with several states, sued to block two proposed health insurer mergers: Aetna/Humana and Anthem/Cigna. On January...more

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against...more

ERISA: Winning Tactic on Summary Judgment to Prove Claimant Received the Policy: Get Key Evidence into the Administrative Record

You know that to apply an exclusion in a policy, the claims administrator must show that the claimant received the policy. But what happens when the claimant submits a declaration disputing your proof that she received...more

Insurance Claims Report Spotlights Risks To Assisted Living Facility Operators

Late last year CNA, one of the nation’s largest commercial insurance companies, issued a report summarizing professional liability insurance claims for senior living facilities that it closed between 2011 and 2015. Although...more

Trump administration issues proposed health insurance market stabilization rule: Will it be enough to stabilize exchange...

On 15 February 2017, the Centers for Medicare & Medicaid Services (CMS) took a step toward addressing concerns about the stability of the individual and small group health insurance markets by proposing a modicum of...more

A tale of two mergers: Following their losses in DOJ merger challenges, Anthem fights on and Aetna gives up

In the past month, the DOJ and several state governments scored two trial wins in their challenges to mergers among some of the country’s largest health insurers. First, Judge Bates of the District of Columbia blocked the...more

340B Drug Pricing Program: The Withdrawal of Mega Guidance and the Future of Patient Definition

In the wake of a recent directive issued by the Trump administration to halt pending regulations and guidance while the new leadership conducts its own review, the Department of Health and Human Services, on January 30, 2017,...more

New SBC Template Goes Into Effect April 1

The U.S. Department of Labor (DOL) released a new template for the Summary of Benefits and Coverage (SBC) last year. As background, the Affordable Care Act requires health plans and health insurers to annually distribute SBCs...more

Fast Take on House Republicans’ “Obamacare Repeal and Replace” Plan

On February 16, 2017, House Republicans issued an “Obamacare repeal and replace” policy brief for members to use in speaking with constituents during the Presidents’ Day break. This repeal-and-replace plan is not yet a...more

Will lawmakers on break get an earful over GOP’s outline for Trumpcare?

Members of Congress are home in their districts for a week-long break, and many lawmakers are expected to get an earful from voters upset over many issues at the start of the Trump Administration, especially this: What the...more

Marketplace Shockwaves: Insurer Exits Leave Marketplaces Vulnerable

Early this month, Aetna announced that in 2018, it will not expand its Health Insurance Marketplace ("Marketplace" or "Exchange") coverage, and is evaluating whether it will completely pull out of the Marketplaces created by...more

CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

On February 17, 2017, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule aimed at reforming and stabilizing the individual and small group health insurance markets. When (or if) finalized, the...more

HHS Makes Its First Move to Stabilize the Individual Health Insurance Market

Wednesday, the Trump Administration released its first proposed regulation seeking to stabilize the individual insurance market – in particular, the Affordable Care Act (ACA) insurance exchange market (or marketplace). Amidst...more

"DOJ Continues Streak of Successful Merger Challenges With Blocked Aetna-Humana, Anthem-Cigna Deals"

In a continuation of recent Department of Justice (DOJ) successes challenging mergers, the U.S. District Court for the District of Columbia recently enjoined two more proposed mergers brought and litigated under the Obama...more

Achieving Health Care Efficiencies through Consolidation and Alternative Models: Irreconcilable Differences?

While debate rages on Capitol Hill over “repeal and replace,” only limited attention has been directed toward reforming the current “fee for service” model. Indeed, both the Affordable Care Act (“ACA”) and proposals for its...more

Floundering GOP gets its ACA repeal-replace architect and tries ‘repairs’

Republicans jammed through their health policy guru in the middle of the night, and they and their new HHS Secretary are still trying to figure out what to do with the Affordable Care Act, aka Obamacare. Insurance markets are...more

Who Cares for Your Aging Family When You Can’t? (Hint: Not Robots) [Audio]

Subscribe to the show in iTunes here: http://itunes.apple.com/us/podcast/who-cares-for-your-aging-family/id1081120870?i=1000380982871&mt=2 Like most people, I didn’t want to think about my parents getting old, getting...more

“Repeal and replace” Obamacare? GOP now talking about ‘repairing’ health act

With its furious attack on the Affordable Care Act, aka Obamacare, has the GOP become the proverbial barking dog that finally caught the bus it has chased for so long? Partisans continue to proffer notions for what might be...more

"Republicans Chart New Course for US Health Care System"

While President Donald Trump made repeal of the Affordable Care Act (ACA) a centerpiece of his 2016 presidential campaign, he offered few details about how he would replace it or address other health care issues. More...more

What Repeal of the Patient Protection and Affordable Care Act (the “ACA”) May Mean to Maryland

According to an issue paper (the “Paper”) published on the Maryland General Assembly’s website, implementation of the ACA in the State has resulted in an increase in health insurance coverage for Marylanders. The Paper points...more

Another Challenge to U.S. on Risk Corridor Payments

Molina Healthcare has joined the long line of insurers suing the government for failure to honor its obligations under the Affordable Care Act’s “risk corridor” program. According to Molina’s 84-page complaint filed Jan. 23,...more

Want to run the government like a business? Bring back the ACA.

Just days after his inauguration, President Donald Trump signed an executive order to delay further implementation of the Patient Protection and Affordable Care Act (ACA). This is just one of many steps the President and...more

Is there operating room for compulsory PI insurance

Since its inception on 30 August 2010, the regulations requiring health professionals to have professional indemnity insurance have lain dormant in a state of moratorium, almost as a distant memory some do not wish to recall....more

One Healthcare Impact of President Trump’s Executive Order – Replacement Plans Emerging

Seyfarth Synopsis: Within hours of his inauguration, President Trump issued an Executive Order labeled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal”. As described in...more

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