OVERVIEW - This report proposes a vision and plan for action—collectively a statewide Health Equity Action Plan—for achieving a racially and ethnically equitable health care delivery system in Massachusetts. The report is...more
Surgeon To Pay Up to $43 Million for FCA Fraud - A Michigan vascular surgeon, Vasso Godiali, was sentenced to 80 months in prison for defrauding health care programs in connection with his submission of false claims for...more
As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more
As the trend of acquisitions of physician practices and mergers of hospitals continues, so does antitrust scrutiny of these deals. There was activity this week in three different proposed transactions that caught the...more
After fending off a motion for judgment on the pleadings in March 2015, a small hospital in Peoria, Illinois lost on summary judgment in its $300 million antitrust suit alleging illegal exclusive dealing and attempted...more
Newkirk Products Inc., which provides ID cards and management services for healthcare organizations, including multiple Blue Cross Blue Shield organizations, has announced that it has discovered that its computer system was...more
The latest development in how American courts will handle the standing question for data breach class actions came last week when the U.S. District Court for the District of Columbia dismissed for lack of standing a putative...more
New study shows Marketplace premiums parallel the employer market; Montana likely to select a private insurer to administer benefits to its Medicaid expansion population; and Washington’s Exchange customers will begin paying...more
Within days of Excellus Blue Cross Blue Shields’ (Excellus) announcement that its data had been accessed by a hacker through a “sophisticated” cyber-attack, two law firms teamed up to file a proposed class action suit last...more
Excellus, a BlueCross BlueShield (BCBS) provider servicing upstate New York, announced last week that it was the latest in a string of BCBS providers that experienced a data breach as a result of a cyberattack. CareFirst...more
Yesterday, Excellus Blue Cross Blue Shield, located in Rochester, NY, announced that it will notify up to 10 million members that it was the victim of a cyber-attack dating back to December of 2013 that exposed their members’...more
CMS permits states to use income information from other means-tested benefit programs for Medicaid eligibility determinations; Alaska’s Medicaid expansion is given the green light to launch today; and Washington State submits...more
The Pennsylvania Superior Court has decided the Pennsylvania Peer Review Protection Act does not apply to alleged peer review activity conducted by Blue Cross of Northeastern Pennsylvania, because Blue Cross is not a...more
Not to be left out, plaintiffs filed suit against CareFirst BlueCross Blue Shield late last week for the hacking incident the insurer suffered in May, which resulted in unknown intruders gaining access to names, dates of...more
BREAKING NEWS: Health insurer CareFirst BlueCross BlueShield disclosed today that hackers gained access to one of its databases, exposing personally identifiable information for approximately 1.1 million people....more
The Texas Medical Association (TMA) and Blue Cross Blue Shield of Texas are launching a new services company, TMA PracticeEdge, to facilitate bringing the benefits of value-based reimbursements to the state’s independent...more
After objecting to the release of hospital reimbursement rates mandated under North Carolina’s Health Care Cost Reduction and Transparency Act of 2013 (NCGS Section 131E-214.5), Blue Cross Blue Shield of North Carolina...more
Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity.[1] Operating with a combined 14 hospitals and approximately 6,000 physicians,...more
When Oklahoma Blue Cross-Blue Shield terminated Dr. Gude’s provider agreement, he decided to fight back. He sued the Blues in federal court, alleging they had violated—and this is the imaginative part—Oklahoma’s Consumer...more
The Blue Cross Blue Shield Association released an interesting survey over the summer (July 2014) that provides further evidence of the change that is now happening in the American healthcare delivery system....more
Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more
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
In early November, Mississippi Governor Phil Bryant rescinded an Executive Order (Executive Order 1327), issued only weeks earlier, that would have compelled Blue Cross of Mississippi to continue to offer “in-network” status...more
Trademarks and service marks are valuable in all areas of commerce, and health care is not an exception. Providers of health care-related goods and services rely upon trademarks and service marks to identify the sources of...more