News & Analysis as of

Avoiding Sticker Shock: A Look Into What Are Considered “Reasonable and Customary” Charges Under 28 CCR §1300.71(a)(3)(B)

In the case Children’s Hospital Central Cal. v. Blue Cross of Cal. (Cal. Ct. App. 2014) ___Cal.App.4th ___ (No. F065603), The Children’s Hospital Central California (“Hospital”) and Blue Cross of California (“Blue Cross”)...more

Medicaid Enrollment Continues to Grow

The U.S. Department of Health and Human Services (HHS) has reported that at the close of April, an additional 6 million Americans have enrolled in Medicaid and related health programs for the poor since the launch of coverage...more

Healthcare Legal News - February 2014 • Volume 4, Number 1

In This Issue: - CMS ISSUES FINAL RULE ON DIRECT ACCESS OF LAB TEST RESULTS BY PATIENTS: On February 3, 2014, the Centers for Medicare and Medicaid Services (CMS) released a final rule that permits patients or...more

Health Alert (Australia) - 28 January 2014

In This Issue: Judgments; Legislation; and Reports. - Excerpt from Reports: - Australia. Department of Health & Ageing: Private Health insurance (PHI) Circulars: ..8 January 2014 - PHI 01/14....more

Mississippi Governor Rescinds Executive Order Requiring Blue Cross of Mississippi to Grant “In Network” Status to Excluded...

In early November, Mississippi Governor Phil Bryant rescinded an Executive Order (Executive Order 1327), issued only weeks earlier, that would have compelled Blue Cross of Mississippi to continue to offer “in-network”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

CMS Releases 2014 OPPS/ASC Final Rule - December 2013

On November 27, 2013, CMS released the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems final rule with comment period for calendar year 2014 (the “Final Rule”). Significantly, CMS...more

Health Insurance Premium Regulation Bid Draws Criticism

Barger & Wolen partners Richard De La Mora and Richard Hopkins were both quoted in a Nov. 14, 2013, Daily Journal article, Hospital insurance premium regulations bid draws criticism, about a proposed ballot initiative...more

“Any Willing Insurer” Legislation Introduced in Pennsylvania

A significant number of states have “Any Willing Provider” statutes that require a health insurer to admit all requesting providers into the health insurer’s preferred provider network. While some of these statutes are...more

HHS: Providers May Be Able to Subsidize Premiums For Uninsured in Marketplace Plans

An announcement October 30 from Health and Human Services Secretary Kathleen Sebelius could remove the first hurdle for providers wishing to offer premium support for individuals eligible for health insurance on the Health...more

OIG Advisory Opinions Provide Some Helpful Guidance

In spite of a slow start, the OIG has issued a number of interesting advisory opinions to date in 2013. Here are a few of the highlights. The OIG reiterated its long-standing concern about arrangements which “carve out”...more

Health Alert (Australia) - 15 July 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Reports: Australia. Department of Health & Ageing Media releases: ..11 July 2013 - $500,000 upgrade of newstead medical officially...more

Healthcare Update, No. 2, May 2013 - Court Upholds OFCCP's Jurisdiction Over Healthcare Providers

A federal district court has confirmed the position of the Office of Federal Contract Compliance Programs (OFCCP) finding that three hospitals providing medical services to U.S. government employees, and receiving payments...more

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