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New Jersey Supreme Court Reminder – Don’t Forget about the Corporate Practice of Medicine

A New Jersey Supreme Court case earlier this summer has New Jersey lawyers re-examining their clients’ business structures under the State’s corporate practice of medicine doctrine....more

Fate of Last-Minute Affordable Care Act Initiatives Uncertain

by Baker Ober Health Law on

This week, the debate over the Affordable Care Act (ACA) gained new momentum in two separate, but connected channels. As the fiscal year (FY) budget reconciliation window enabling expedited passage of an ACA repeal draws to a...more

GOP Tries “Repeal and Replace” One More Time as Clock Runs Out

by Epstein Becker & Green on

Senate Republicans, frustrated by their failure to repeal and replace the Affordable Care Act (ACA) during the summer, are trying once again. They have only until September 30, according to a ruling by the Senate...more

Health Care Weekly Preview from ML Strategies – September 2017 #2

Welcome back everybody. The House is out this week and the Senate is out Thursday and Friday with a lot to sort out before they skip town. Graham-Cassidy has people on edge because, if nothing else, it is still alive. The...more

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

Health Care Reform Returns to the Spotlight

by Foley & Lardner LLP on

Congress is now back in session and, once again, focus has turned to health care. With all eyes on returning health care reform to the forefront, a flurry of activity has sparked new legislative efforts including the...more

Beltway Buzz - September, 2017 #3

He Said, They Said. Over a Wednesday night dinner consisting of the unusual combination of Chinese food and chocolate pie, President Trump and Democratic congressional leaders Charles Schumer (D-NY) and Nancy Pelosi (D-CA)...more

GOP senators trying to sneak in one more push to repeal, replace Obamacare

As the 40th President of the United States used to mutter, well, there they go again. The Republicans in the 115th Congress apparently will make another go at repealing and replacing the Affordable Care Act, what may be...more

Are You In Compliance With The Notice Requirements of the Nondiscrimination Rules?

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Covered Entities that receive Federal financial...more

Health Care Weekly Preview from ML Strategies – September 2017

“It’s déjà vu all over again.” We’re back again this week for an important round of hearings in HELP and Finance where we will be paying close attention to the tone emanating from the hearings especially after Chairman...more

Medical Marijuana 104: Responsibilities of Health Insurers

by Farrell Fritz, P.C. on

It will come as no surprise that patients who are thinking about getting certified for medical marijuana use have a number of questions relating to the cost of obtaining medical marijuana products....more

Impact of Value-Based Health Care on the Medical Device Industry: Three Takeaways From the Case for Transformation

by Ropes & Gray LLP on

Introduction: The Case for Transformation - In the world of fee-for-service health care, most medical devices were sold to hospitals or other health care providers for use in the diagnosis or treatment of patients. Except...more

Health Care Reform Roundup – Issue 9

After health care reform efforts failed in late-Spring/early-Summer, things have been quiet. However, Congress returned to DC this week. Although legislative focus now appears to be on general tax reform, we expect some...more

Health Alert (Australia) 4 September 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 30 August 2017 - Australian Competition and Consumer Commission v Medibank Private Limited [2017] FCA 1006 - In this proceeding,...more

26 Days: Congress and Health Care as FY 2017 Comes to a Close

by Epstein Becker & Green on

Congress returns from August recess today, facing a daunting workload to complete before the end of the current fiscal year (FY) on September 30. Big picture issues include raising the national debt ceiling and passing a...more

D.C. Circuit Holds Cyber-Theft of Customers’ Medical Identifying Information Created Sufficient Increased Risk of Harm to...

Earlier this month, an appellate panel of the federal DC Circuit unanimously held that individuals affected by a healthcare insurer’s data breach in 2014 could pursue claims against the insurer stemming from the cyberattack....more

Specialty Pharmacy's Antitrust Claim against Humana Fails

by Baker Ober Health Law on

On August 9, District Judge Susan Wigenton (D. NJ) issued a ruling in Prime Aid Pharmacy v. Humana, Civ. No. 16-2104, granting Humana's motion to dismiss the plaintiff's Second Amended Complaint, finding that the plaintiff...more

Value-based health care: the role of payors

by Ropes & Gray LLP on

Bill Knowlton, Ropes & Gray health care partner, examines the critically important role of payors in value-based health care programs. ____________ Payors are critically important to value-based health care because they're...more

Aetna and its Vendor Face Class Action Lawsuit over HIV Disclosure

A Pennsylvania man has filed a class action lawsuit against Aetna Inc., accusing it of violating his privacy rights when the insurer mailed him prescription information in an envelope with a large, clear window that disclosed...more

Ripeness: A Question of Subject Matter Jurisdiction - Allied World Surplus Lines Insurance Company v. Blue Cross and Blue Shield...

by Nexsen Pruet, PLLC on

Addressing a contractual requirement to exhaust Alternative Dispute Resolution (ADR) prior to commencing litigation, the United States District Court for the District of South Carolina chose to forge its own path, rejecting...more

The Ninth Circuit Weighs in on ERISA’s Plan Document and Summary Plan Description Requirements: Mull v. Motion Picture Ind. Health...

Mull v. Motion Picture Ind. Health Plan educates employers on the basics of the requirements of the Employee Retirement Income Security Act (ERISA) governing plan documents and summary plan descriptions. The lessons are...more

Recent 11th Circuit Decision Is a Victory for Health Care Providers Challenging Insurer Reimbursement Decisions and a Reminder of...

by K&L Gates LLP on

The existence and scope of assignments of benefits from patients to health care providers continues to be critically important to a provider’s ability to challenge an insurer’s reimbursement decision under the Employee...more

Massachusetts Employers Face $200 Million Increase in Health Care Costs under MassHealth Amendments

On August 1, Massachusetts Governor Charlie Baker signed into law H. 3822, “An Act Further Regulating Employer Contributions to Health Care” (the “Act”). The purpose of the Act is to shore up the finances of the...more

New Guidance on Coverage for Eating Disorders

by Tucker Arensberg, P.C. on

The Departments of Labor, Treasury, and Health and Human Services recently released a frequently asked question (“FAQ”) regarding the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction...more

Health Alert (Australia) 14 August 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 10 August 2017 - Inquest into the Death of Stephen Herczeg 57/2016 (1808/2016) - The said Court finds that Stephen Herczeg aged 72...more

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