Reimbursements

News & Analysis as of

Also In The News - Health Headlines - January 2016 #3

CMS Finalizes Medicaid Prescription Drug Rule – On January 21, 2016, CMS finalized a rule detailing reforms to the rebate and reimbursement systems for Medicaid prescription drugs, which the agency estimates “will save...more

Partnering with nonprovider sites: Tips to keep in mind

Provided applicable requirements are met, the Medicare program reimburses teaching hospitals for resident training that occurs both at the hospital itself and at clinical nonprovider locations, including, for example,...more

Employers Can Demand Departing Employees Repay Training Costs

Training new employees is expensive. That is particularly true when an employer offers to pay for an employee’s educational training. The benefits of doing so include a more educated and well-trained workforce, as well as...more

Supreme Court Clarifies Limits on Tribes' Self-Determination Contract Support Costs Claims

The U.S. Supreme Court ruled on Jan. 25, 2016, against the Menominee Indian Tribe of Wisconsin (Tribe) in Menominee Indian Tribe of Wisconsin v. United States, et al., 577 U.S. ___ (2016) regarding its claims that the Indian...more

No Free “Train” Ride for This Ex-Employee: Court Sides With Employer And Orders Quitting Employee To Pay Back Training Costs

In USS-Posco Industries v. Floyd Case (Ct. of Appeal A140457), published January 26, 2016, the Court of Appeal for the First Appellate District enforced an agreement requiring an employee to repay the costs of employer paid...more

Supreme Court Issues Further Clarification on Equitable Relief Remedies Available Under ERISA

ERISA Section 502(a)(3) empowers plan fiduciaries to file suit “to obtain … appropriate equitable relief … to enforce … the terms of the plan.” In 1993, the Supreme Court of the United States interpreted this ERISA provision...more

Circuit Court Affirms Bankruptcy Order Requiring Creditor to Reimburse Trustee for Maintaining Collateral

In the case of Domistyle, Inc., 14-41463 (5th Cir. Dec. 29, 2015), the United States Court of Appeal for the Fifth Circuit affirmed an order of the bankruptcy court requiring a secured creditor to reimburse the trustee for...more

Supreme Court Limits ERISA Plan Reimbursement Rights: ERISA Fiduciaries Need to be Diligent

On January 20, 2016, the United States Supreme Court held that an ERISA plan could not satisfy its reimbursement rights from a participant’s general assets. ERISA plans’ reimbursement rights are now so limited that...more

Bad News for ERISA Plan Reimbursements: Chase The Money Before Settlement Funds Dissipate, Supreme Court Rules

This just in…. A big debate was resolved today by the United States Supreme Court: Can an ERISA plan sue to recover medical expenses paid on the participant’s behalf after the settlement funds have dissipated?...more

Reimbursement of Employee Political Contributions Could Lead to Jail Time for CEO

Recent charges against a Pennsylvania CEO serve as a reminder of how important it is for corporate counsel and executives to ensure that corporate funds are not being used to support political candidates in violation of...more

DOL Issues Guidance on Room and Board Deductions for Home Care Workers

On December 17, 2015, the U.S. Department of Labor’s (DOL) Wage and Hour Division issued guidance on permissible deductions for lodging under the Fair Labor Standards Act (FLSA), with particular emphasis on the law’s effect...more

Court Allows Class Member Self-Identification Where Employer Failed to Retain Records

The Northern District of California recently certified a class of employees in an action against an auto parts store for failure to reimburse expenses. Plaintiff alleged that the defendant required certain management-level...more

Defense Wins Motion Regarding Damages in Fernandez v. City of Phoenix

Donald L. Myles, Jr., Lori L. Voepel, Michele Molinario, and Justin M. Ackerman previously obtained a win for the City of Phoenix at the Superior Court of Arizona. Plaintiffs, assignees of former Phoenix police officer...more

Supreme Court to decide whether implied certification theory of False Claims Act liability is viable with likely significant...

Last Friday, the US Supreme Court granted certiorari in Universal Health Services, Inc. v. United States and Massachusetts ex rel. Escobar and Correa, No. 15-7. The Court will decide whether federal government contractors can...more

State Lawmakers Pushing Telemedicine Coverage in 2016

State legislation is heavily contributing to the expected reimbursement/coverage uptick in 2016, as more states consider legislation requiring coverage for telemedicine and in-person visits alike. To date, 29 states...more

The Impact of the Bipartisan Budget Act of 2015 on Off-Campus Hospital Outpatient Departments

On November 2, 2015, President Obama signed the Bipartisan Budget Act of 2015 (“Act”) into law significantly impacting how Medicare pays certain off-campus hospital departments. Specifically, Section 603 of the Act provides...more

Payers Embracing Telemedicine Cost Savings, Ramping Up Reimbursement in 2016

Often considered the primary obstacle to telemedicine implementation, reimbursement changes are now better viewed as one of the most prominent drivers of telemedicine expansion. Payers are finally beginning to realize what...more

ERISA: Medical Providers Lack Standing For Reimbursement — Anti-Assignment Provisions Enforceable

You know that patients typically assign rights under a health insurance plan to the provider of medical services. This is accomplished by signing an assignment form upon intake/admission. Then, the healthcare provider sends...more

Sharing Economy Should Fear California's Ruling on Uber Driver

When a district court judge in San Francisco this summer certified a class of Uber Technologies Inc. drivers seeking compensation for tips, it may have been the most talked about legal story of the summer. Much less noticed,...more

Final Curtain Call for Tuomey: Long-Running FCA/Stark Case Settled

After 10 years of litigation, including two trials and appeals to the 4th Circuit Court of Appeals, the U.S. Department of Justice (DOJ) and Tuomey Healthcare System (Tuomey) have entered into a settlement of DOJ's action...more

Beyond residency: How the Medicare program treats fellowship training

Teaching hospitals are often responsible for the clinical training of three different categories of trainees: - Interns, or trainees in their first year of residency training - Residents, or trainees who have...more

New York City Transit Benefit Requirement Fast Approaching

As most New York City employers know by now, beginning January 1, 2016, the New York Mass Transit Benefits Law (the "ordinance") requires employers with twenty or more full-time employees working in New York City to offer...more

Budget Deal Alters Reimbursement to Off-Campus Hospital-Owned Facilities

On November 2, 2015, President Obama signed into law H.R. 1314, the Bipartisan Budget Act of 2015 (the "Act"), which significantly changes Medicare reimbursement for off-campus hospital services. The Act, which Congress...more

Three Pressing Challenges for Personalized Medicine

Personalized medicine can be described as the science of targeted therapies. Advances in diagnostic and molecular medicine have made it possible to more precisely identify alternative treatment options for patients based on...more

No False Claims Act Case Where There is No False Claim – DNJ Throws Out Qui Tam Action Against Genentech

Halloween has come and gone. The Drug and Device Law Little Dogs stayed in their costumes (Batgirl and a rabbi) long enough to be photographed for (unsuccessful) entries for a pet costume contest. There was ample candy –...more

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