Medical Expenses

News & Analysis as of

Maine Workers' Compensation Alert: CMS Guidelines Amended to Accept WCB Settlement Determination of MSA Amount After Hearing on...

The Center for Medicare and Medicaid Services (CMS) update to its Workers' Compensation Medicare Set-Aside (WCMSA) Arrangement Reference Guide provides authority by which CMS will now recognize and defer to a Workers'...more

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

Changing Financial Landscape for Medical Debts of the Uninsured

The implementation of the ACA has afforded many with the opportunity to obtain insurance coverage. Despite the opportunity, a large number of individuals have either chosen not to enroll in a health plan or have been unable...more

Supplemental Special Advisory Bulletin Clarifies OIG Positions on Independent Charity Patient Assistance Programs

Introduction - The OIG has released a Supplemental Special Advisory Bulletin that “reiterates and amplifies” previous OIG Special Advisory Bulletin guidance from 2005. Pharmaceutical manufacturers and Patient...more

CFPB Releases Report on Medical Debt and Consumer Credit Scores

The CFPB’s Office of Research released a report showing findings that medical debt that goes into collections and shows up on credit reports may result in over-penalization with regard to consumer credit scores. The study...more

CFPB issues report on how medical debt impacts credit scores

According to a report issued yesterday by the CFPB entitled “Data point: Medical debt and credit scores,” credit scoring models may be overly penalizing consumers with medical debts that go into collection by producing credit...more

Cost Caps on Medical Procedures Approved

Federal officials recently approved “reference pricing,” a new cost-control mechanism that allows insurers to put a dollar limit on the amount that health plans pay for some expensive medical procedures, such as knee and hip...more

Affordable Care Act Avoidance Scheme: If It Looks Too Good To Be True …

A questionable ACA avoidance scheme has recently come to my attention. The scheme purports to significantly reduce costs associated with ACA compliance by using a so-called Medical Expense Reimbursement Plan or “MERP.” Under...more

An Award of Future Medical Damages is Not Automatic

Barry P. Goldberg counsels his clients that an award of future medical damages is not automatic. In fact, future medical expenses must be carefully presented both at the claim stage and in litigation. Not only must the future...more

Plan C for Your Plan B - Using Excepted Benefits to Maximize Cost Savings under Obamacare for Small Businesses: Non-Coordinated...

Overview - The Godfather trilogy is one of my favorite movie series. My mother was Italian American with both parents from the Old Country. What is the connection between these Oscar winning films and Obamacare?...more

Keeping Track of Your Injuries

Anyone who has been seriously injured in an accident knows how jarring it can be in an already busy life. If you suffered an injury and are interested in pursuing legal action, there are several things you should start doing...more

Illinois Supreme Court to Decide Whether Courts Can Award Child Support From Custodial to Non-Custodial Parents

Our previews of the newly allowed petitions for leave to appeal from the closing days of the November term continue with In re Marriage of Turk, which poses a potentially ground-breaking question of domestic relations law:...more

How to Stop Getting Medical Bills on Your Nevada Work Comp Claim

Injured workers with accepted workers' compensation claims should not be getting bills for medical treatment from hospitals, doctors, an anesthesiologist, or radiologist. You know whether you have an accepted claim or not...more

Hailey French’s Story – When millions barely cover the bills

When our client Hailey French was awarded a $5.5 million verdict in her personal injury case against a drunk driver and two government agencies that were also negligent, we heard some backlash from folks who couldn’t...more

Health Savings Accounts - Where Banks and the Future of Health Care Meet?

Since 2003, when Congress created the Health Savings Account (HSA), banks have been involved in helping employers and individuals set up the accounts to fund future health care costs. HSAs are increasingly striking a chord...more

Repayment And Lien Matters In Personal Injury Cases

You may not realize that if you received certain types of medical insurance benefits for your accident injuries, you may need to repay some of it. The law allows many insurers to recover a portion of what they paid on your...more

Health Care and Bankruptcy in Arizona

Getting sick can be very expensive. Many of the bankruptcy cases I file here in Arizona have a large amount of medical bills. And things don’t look to be getting any better. I just renewed my health insurance for my family...more

Three aspects of personal injury claims that surprise our clients

As an attorney who exclusively practices personal injury law, I talk to a lot of people who have recently been involved in automobile collisions. Very few of these folks have ever been involved with any aspect of the legal...more

What Happens in a Personal Injury Case?

Personal injury claims can be filed for any injury caused by someone else’s recklessness, wrongdoing or lack of regard. They can arise from car accidents, pedestrian and bicycle accidents, slip and fall accidents and medical...more

Bill Introduced to Curtail the Stark Law's In-Office Ancillary Services Exception

On August 1, Rep. Jackie Speier (D-CA) introduced H.R. 2914, the Promoting Integrity in Medicare Act. The legislation would provide that the Stark Law's in-office ancillary services (IOAS) exception is not available for...more

An Insurer Cannot Claim That It Was Unaware of Claims Handling Statutes As A Defense To Bad Faith

The South Dakota Supreme Court in Bertelsen v. Allstate Insurance Co., 833 N.W.2d 545, No. 26442 (June 12, 2013) (1) held that an insurer cannot avoid bad faith liability by claiming it did not know about controlling claims...more

A Continued Examination of Charitable Patient Assistance Programs - Part Seven in a Series: Charitable PAPs: Donations and...

In today’s challenging health care environment, Charitable Patient Assistance Programs (Charitable PAPs) have emerged to meet the needs of the nearly 30 million Americans that are underinsured and have difficulty paying...more

IPPS Final Rule: CMS Addresses Allina Decision and Addresses New Medicare DSH Payment Calculations

In the fiscal year 2014 Inpatient Prospective Payment System (IPPS) rule published in the Federal Register on August 19, 2013, CMS took two steps of note regarding the Medicare disproportionate share hospital (DSH)...more

A Review of CMS' Approach to $125 Million Recoupment of Payments to Providers for Services to Incarcerated / Unlawfully Present...

CMS seeks to recover from providers $125 million in alleged overpayments for services to beneficiaries who are belatedly identified as ineligible (incarcerated/unlawfully present). In this post, Sheppard Mullin examines the...more

Trouble Ahead for One-Day Inpatient Stays: New Pre-Billing Challenges Loom

On Aug. 19, CMS published a final rulemaking that may effectively eliminate DRG Part A payments for most acute care inpatient stays of one day....more

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