Reimbursements

News & Analysis as of

Sixth Circuit Holds That Michigan Health Insurance Claims Assessment Act Falls Outside of ERISA’s Preemptive Reach

Whether state common law claims are preempted by the Employee Retirement Income Security Act of 1974 (ERISA) is a common issue in reimbursement disputes involving health care providers and insurance companies. In cases when...more

Does Digital Health Need Reimbursement?

One of the most talked about topics when it comes to digital health is the reimbursement under various third-party payer programs. Most notably, telemedicine and remote monitoring have received a lot of attention, and the...more

Year of the Bundle: CMS Proposes New Mandatory Cardiac Bundles and Expansion of CCJR

The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule that furthers the U.S. Department of Health and Human Services’ goal to promote cooperative, value-based care and tie at least 50 percent...more

Insurance News, Summer 2016

Eight Years after Bi-Economy and Panasia, What is the Law of Bad Faith in New York? Prior to 2008, the law of bad faith in New York seemed fairly well established. A claim for bad faith against an insurer, which might...more

Cumis Counsel’s Post-Settlement Conduct is Not Protected from Insurer’s Reimbursement Lawsuit Under California’s Anti-SLAPP...

In Travelers Cas. Ins. Co. of Am. v. Hirsh (No. 14-55539), the United States Court of Appeals for the Ninth Circuit upheld an order denying the appellant’s motion pursuant to California’s anti-SLAPP statute, to strike...more

Local Government Travel and Entertainment Expenses Come Under Greater Scrutiny with New Law

Over the past few years there has been no shortage of FOIA requests and media attention on how school districts and other units of local government spend or reimburse spending on conferences, dining, and travel. Last week...more

Florida’s Telehealth Advisory Council Appointed

Florida’s Agency for Health Care Administration (AHCA) announced, on July 27, 2016, the appointments of 13 representatives to the newly-created Florida Telehealth Advisory Council. The Telehealth Council was created through...more

New Illinois Law Requires Local Public Agencies to Regulate Travel Expenses

In the wake of numerous recent examples of extravagant spending by some Illinois local governments and agencies, the Illinois General Assembly sent Gov. Bruce Rauner a bill designed to increase the accountability of local...more

CMS’ Web Portal: Final Rule 21 CFR § 411.39 Promises Quick and Efficient Conditional Payment Resolution for Those Able to Abide by...

The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule entitled “Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal.” From the outset of...more

Rhode Island’s New Law Requires Health Plans Cover Telemedicine Services

Rhode Island marks the 31st state to enact a telemedicine commercial reimbursement statute. The Telemedicine Coverage Act (HB 7160B) was signed into law by Rhode Island Governor Gina Raimondo on June 28, 2016, representing a...more

The State of Telehealth - Policy and Reimbursement Q&A

Foley Partner Nathaniel Lacktman, head of the firm’s telemedicine and virtual care practice, participated in a comprehensive Q&A discussing the challenges and opportunities facing the telehealth market with Healthcare...more

Good News! New 409A Regulations (Yes, Really!) – Part 1: Firing Squad

On the TV show Futurama, the aged proprietor of the delivery company Planet Express, Professor Hubert J. Farnsworth, had a habit of entering a room where the other characters were gathered and sharing his trademark line,...more

E-Rate Program Proposed Expansion

FCC Looking to Increase Eligibility for Reimbursement - The Federal Communications Commission is seeking comments on a proposal to expand what services are eligible for reimbursement under the E-rate eligible services...more

Florida Court Rejects Auto Body Shops' Effort to Revive their Antitrust Claims Against the Auto Insurance Industry

On May 12, District Judge Gregory Presnell (Middle District of Florida) denied plaintiffs' motion for reconsideration in the In re Auto Body Shop Antitrust Litigation, delivering another victory to insurers seeking to derail...more

Medicaid in Iowa: What's Next

In my previous blog post, I provided a brief history of Medicaid in Iowa, including sharing details on it’s current modernization and challenges. In this post, we’ll cover what’s next for Medicaid members with the move to...more

It’s All a Matter of Degree – Fourth Circuit Upholds Four-Year Front Pay Award and Tuition Reimbursement in SOX Case

Affirming a SOX victory for an employee, the Fourth Circuit in a 2-1 decision in Gunther v. Deltek upheld a Department of Labor award of four-years of front pay to a former financial analyst of a software firm and also...more

SCOTUS Decision on Implied Certification Theory of Liability Under FCA Leaves Many Questions Unanswered

The U.S. Supreme Court handed down an important decision on June 16, 2016 that expands the scope of liability under the False Claims Act, 31 U.S.C. §§ 3729-3733, (the FCA). In Universal Health Services, Inc. v. United...more

New York Legislation to Require Payment Parity for Telehealth Services

New York introduced a new bill designed to ensure commercial health plans pay for telehealth services at the same rate the plans pay for in-person services. The legislation, SB 7953, comes on the heels of New York’s...more

New IRS Memo Confirms Tax Treatment of Wellness Programs & Incentives

In a recently released IRS Chief Counsel Memo, the IRS confirmed that wellness incentives are generally taxable. The memo also, indirectly, confirmed the tax treatment of wellness programs more generally....more

One Bite at the Apple: Section 502(e)(1)(B) and the Disallowance of Redundant, Contingent Claims

Section 502(e)(1)(B) of the Bankruptcy Code allows debtors to seek disallowance of certain types of contingent claims to avoid being twice liable on a single obligation. It has the added benefits of facilitating debtors’...more

Ways and Means Committee Approves Bill to Make Reforms to Medicare Hospital and Other Payment Policies

The House Ways and Means Committee has approved an amended version of H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016.” While most of the provisions address Medicare payment policies pertaining to...more

Complexities of Administrative State Lead to Win for Regulated Community

Caring Hearts Personal Home Serv., Inc. v. Burwell, a U.S. Court of Appeals for the Tenth Circuit Medicare reimbursement case, describes the challenges confronting federal administrative agencies and the regulated community...more

RushCard Settles Service Disruption Suit for $20.5M

RushCard will pay a total of $20.5 million to settle a lawsuit over an incident that resulted in thousands of consumers being shut out of their prepaid card accounts last October....more

5 Wishes for Securities Litigation Defense: Greater Insurer Involvement in Defense-Counsel Selection and Strategy

One of my “5 Wishes for Securities Litigation Defense” last month was for greater D&O insurer involvement in securities class action defense. This simple step would have extensive benefits for public companies and their...more

Federal District Court Confirms Arbitration Award In Hospital Services Dispute

Weirton Medical Center, Inc. (“WMC”), a hospital in West Virginia, entered into an agreement with QHR Intensive Resources, LLC, under which QHR provided hospital administrative services. WMC ultimately terminated the...more

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