Mergers & Acquisitions Health Insurance

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DOJ and FTC Announce Proactive Approach to Monitoring Post-Affordable Care Act Antitrust Compliance at Joint Workshop

On February 24 and 25, the DOJ and FTC held their second joint workshop to examine the state of health care competition in the United States. The workshop explored five main themes: early observations regarding accountable...more

FTC and DOJ Host Workshop Examining Health Care Competition - Updated 2015

The Federal Trade Commission (FTC) and the Antitrust Division of the U.S. Department of Justice (DOJ) held a public workshop on February 24–25, 2015, to examine recent trends and developments in health care provider...more

In it Together -- Emerging Joint Venture Structures for Hospitals and Insurers

Locke Lord lawyers Jon Biasetti, Baird Allis and Benjamin Sykes provide a detailed look at recent efforts by hospitals, physician practice groups and health insurance and managed care companies to lower health care delivery...more

Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and...more

Insurance Antitrust Legal News - November 2014 - Volume 3 - Number 6

Plaintiff Files Third Amended Antitrust Claim Against Highmark - A long running antitrust dispute in Western Pennsylvania continued on October 1, when a Pennsylvania hotel (Cole’s Wexford Hotel) filed a third amended...more

Affordable Care Act in Mergers and Acquisitions: New Guidance from Internal Revenue Service

In Notice 2014-49, the Internal Revenue Service (“Service”) issued guidance on how to avoid potential penalties under the Affordable Care Act (“ACA”) in connection with mergers and acquisitions (“M&A”). The notice provides a...more

Health Systems Continue To Acquire Insurers

The wall between health care providers and health insurers continues to erode, as Ascension Health’s CEO acknowledges Ascension is in talks to acquire WellCare Health Plans. Ascension is the nation’s largest nonprofit health...more

Expect Focus On Antitrust Issues In The Health Care Industry

There have been a number of high profile antitrust cases brought against health care providers, and the increasing interest of both the Federal Trade Commission (FTC) and plaintiffs should be considered in any proposed...more

Insurance Antitrust Legal News - March 2014 • Volume 3, Number 2

In This Issue: - FTC COMMISSIONER CRITICIZES PROPOSED LEGISLATION THAT WOULD PERMIT HEALTH PROVIDERS TO NEGOTIATE JOINTLY WITH HEALTH INSURERS: In a February 26 speech before the Connecticut Bar Association,...more

Pay to Play Quickly — CMS's New Slow Motion Surveys for Acquirers Rejecting Assumption of Medicare Agreements

The Center for Medicare and Medicaid Services (CMS) recently issued a policy memorandum to state survey agency (SSA) directors regarding the effect of rejecting a Medicare agreement in connection with the acquisition of a...more

CMS Policy Memorandum Clarifies Disincentives to Buyer’s Rejection of Seller’s Medicare Agreement

In a September 6, 2013, policy memorandum, effective immediately, the Centers for Medicare & Medicaid Services (CMS) detailed its policy ensuring that providers that choose to reject assignment of the seller’s Medicare...more

Health Care E-Note - June 19,2013

In This Issue: - FTC Hospital Merger Investigation Highlights Cost of Health Care - Survey Finds Doctors Warming to Health Information Exchanges - Health Insurance Markets Seeing More Competition from New...more

Sixth Circuit in MedQuest: No FCA Liability for Violation of Medicare Conditions of Participation Without Violation of Conditions...

On April 1, 2013, the U.S. Court of Appeals for the Sixth Circuit overturned an $11.1 million False Claims Act (FCA) judgment by the U.S. District Court for the Middle District of Tennessee against MedQuest Associates, Inc.,...more

Insurance Antitrust Legal News - March 2013 • Volume 2, Number 2

In This Issue: - MULTIPLE BILLS INTRODUCED IN CONGRESS TO REPEAL HEALTH INSURERS’ ANTITRUST EXEMPTION: Over the course of the last two months, four separate bills have been introduced in the House of Representatives...more

China Life Sciences Health Industry Client Briefing – January 2013 (February 21, 2013)

In This Issue: Li Keqiang Comments from the 12th Plenary Meeting of the Medical Reform Leading Group (USCBC 2012-01-06) – January 6, 2013; MOH Announces Roadmap for Medical Reform (USCBC 2012-01-10) – January 10, 2013;...more

Insurance Antitrust Legal News - September 2012 • Volume 1, Number 3

In This Issue: - 6th Circuit Holds McCarran-Ferguson Act Bars Antitrust Claims against Title Insurers by James M. Burns: On July 17, the Sixth Circuit Court of Appeals issued its long awaited decision in Katz v....more

Getting Healthy Together

Originally Published in The Recorder, September 4, 2012. A whole lotta conjunctions goin' on with California health care system players, an exceptional surge of large acquisitions and consolidations, some with surprising...more

Life Sciences Health Industry China Briefing - June 2012 (July 20, 2012)

In This Issue: - China's Compulsory License Rule Has Drug Companies On Edge (Law360 2012-06 12) — June 14, 2012 - Beijing to Carry out Pilot Project of Separation of Dispensing from Prescription: Medical...more

Health Care Legal News - July 12, 2012 • Volume 2, Number 6

In This Issue: - SUPREME COURT TO HEAR FTC CHALLENGE TO GEORGIA HOSPITAL MERGER By: James M. Burns - On June 25, the United States Supreme Court granted a request by the Federal Trade Commission (FTC) for...more

Going Vertical: The Hospital-Health Insurer Merger

In today’s health care reform environment, “efficient health care delivery,” “stemming soaring health care costs,” and “improving outcomes” are just a few of the many often-stated goals. The proper role of antitrust...more

Department of Justice Requires Divestitures to Preserve Competition for Medicare Advantage Plans

Under a proposed settlement agreement with the Department of Justice (DOJ), private insurers Humana Inc. (Humana) and Arcadian Management Services, Inc. (Arcadian) must divest certain of Arcadian’s assets in parts of five...more

Leaving the Mothership - Employee Benefits for Spin-Offs

When acquiring a spin-off from a corporate parent, benefits are key to post closing success and minimizing employee disruption. Employee benefits represent significant costs for middle market companies but are critical to...more

Insurer to Purchase Vertically Integrated Medicare Advantage Plan/Provider

WellPoint, one of the nation’s largest health insurers, has agreed to buy CareMore for approximately $800 million. WellPoint, which holds the license for Blue Cross in California and for Blue Cross Blue Shield in several...more

Accountable Care Organizations

In this presentation: Basic Premise for ACOs; Dr. Berwick – CMS Administrator; ACO Vision; Medicare Shared Savings Program and Medicare Accountable Care Organizations: Section 3022 of Affordable Care Act; Organizations that...more

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