Reimbursements

News & Analysis as of

Are You Still Reimbursing Premiums For Your Employee's Individual Healthcare Insurance? Then You'd Better Read This!!

In the past, many employers (especially smaller companies) have offered to pay their employees’ premiums for individual healthcare insurance instead of sponsoring their own group health plans. With the advent of the...more

Court Finds Faulty Funding Provisions in Affordable Care Act Affect Low-Income Affordability Provisions

On Thursday, May 12, 2016, a federal district court judge ruled against the Obama administration, finding that no appropriations have been made to fund payments under Section 1402 of the Affordable Care Act to reimburse...more

Provider-Based Update: Congress Offers Encouraging Step to Reduce Scope of BBA Reimbursement Reductions

On Wednesday, members of the House Ways and Means Health Subcommittee introduced bipartisan legislation that would provide some welcome relief to hospitals who had already invested resources to develop new provider-based...more

Site-Neutral Billing Exemptions

The Balanced Budget Bill Act of 2015 has a site-neutral billing provision relating to off-campus hospital outpatient departments (HOPDs). Those are facilities away from the hospital campus but certified as part of the...more

Judge rules HHS can't pay cost-sharing subsidies to QHPs, but allows funding to continue

More than six years after the Affordable Care Act (ACA) was enacted, legal challenges continue to thread their way through the judicial system. In a May 12, 2016 decision, US District Court Judge Rosemary M. Collyer, an...more

Despite Barriers, Community Speciality Clinics are Eager to Adopt Precision Medicine Tools

Fueled by technological advances, scientific breakthroughs and significant financial investments, precision medicine (PM) has emerged as a promising approach to disease prevention and treatment. A multi-faceted solution to...more

House Republicans Win Challenge to ACA Cost-Sharing Subsidies

On May 12, 2016, the U.S. District Court in Washington, D.C. ruled in favor of House Republicans, concluding that the government wrongly spent billions reimbursing insurance companies for providing discounted health coverage...more

House of Representatives v. Burwell: Another Blow to Obamacare

Federal Judge Rosemary Collyer’s May 12, 2016 ruling in House of Representatives v. Burwell, found that the Obama administration (the “Administration”) has been improperly funding an Obamacare subsidy program. House of...more

District Court Rules One Aspect of ACA is Unconstitutional—No Change for Employers

You may have heard that a federal District Court ruled that the ACA was unconstitutional today. Do not start making any changes. This decision will not directly impact most employers and their health plans. We are sending...more

A District Court Just Dealt a Blow to the ACA. Employers, Don’t Get Excited!

On May 12, 2016, the United States District Court for the District of Columbia issued an opinion in U.S. House of Representatives v. Burwell et al., No. 14-1967 (D.D.C. May 12, 2016), enjoining the federal government’s use of...more

Insurers Gain Additional Dismissals in the Florida Auto Body Action

In early 2014, a group of Florida auto body shops sued the leading auto insurers in their state, alleging that the insurers had conspired to suppress the amounts the auto body shops received in reimbursement rates. The case,...more

Court Holds that Insurer is Liable for Contractual Prevailing Party Attorney’s Fees Following Unsuccessful Defense Fee...

In Hearn Pacific v. Second Generation Roofing (no. A142203, filed 5/2/16), a California Court of Appeal held that despite prosecuting an indemnity action against a subcontractor for reimbursement of defense costs in the name...more

Failure to Disclose Best Pricing: Pharmaceutical Companies Settle FCA Claims for $784 Million

The Department of Justice announced late last month that pharmaceutical manufacturers Wyeth and Pfizer would pay $784 million to resolve a False Claims Act investigation and qui tam lawsuit arising from Wyeth’s failure to...more

Insurance Antitrust Newsletter - May 2016

Insurer Antitrust Exemption in Europe in Jeopardy - In the United States, the McCarran Ferguson Act provides insurers with an exemption from the federal antitrust laws. Enacted in 1945, the Act provides that conduct that...more

After New York, Florida Curbs Surprise Bills for Emergency and Out-of-Network Services

It is generally understood that if a managed care member utilizes the services of a non-participating provider, the member could incur significant out of pocket expenses. However, there are instances where a member may...more

According to the Right and Good of Ancient Law

“You don’t know what you don’t know” is a popular catchphrase. So, do you know what a “betterment” is and how the law of betterments operates? Land use law has ancient roots. Sometimes, a case requires an appellate...more

SCOTUS Oral Argument Suggests FCA Implied Certification Theory Is Here to Stay – But Perhaps with Limits

Oral argument in Universal Health indicates Justices disinclined to categorically reject False Claims Act implied certification theory, though may limit its scope. On April 19, 2016, the United States Supreme Court heard...more

Supremes Hear Argument on Implied Certification Theory

On April 19 the U.S. Supreme Court heard oral argument in Universal Health Services v. U.S. ex rel. Escobar. That’s the case in which the First Circuit upheld a whistleblower suit brought against a mental health clinic that...more

The California Edition of the Employment & Labor Newsletter

Take a Seat! California Supreme Court Provides Clarity on California’s Suitable Seating Laws - A recent ruling by the California Supreme Court on suitable workplace seating arrangements will affect a vast number of...more

FHA Announces Final Revisions to Loan-Level Certification Form

On March 15, 2016, the Federal Housing Administration (FHA) announced final changes to its loan-level certification form, 92900-A HUD/VA Addendum to the Uniform Residential Loan Application. The announcement represents...more

Smooth Operators: Seventh Circuit Untangles Objections and Affirms Settlement of Hair Product Class

The Seventh Circuit Court of Appeals affirmed a class settlement over objection in a case involving a hair-smoothing product (“the Smoothing Kit”) that allegedly destroyed users’ hair and burned their scalps. Plaintiffs sued...more

What’s In a Name? Not Much, Says Colo. Federal Court

On March 31 a federal court in Colorado threw out a suit by 80 chiropractors against several national health insurers. The chiropractors alleged that the insurers violated Colorado law by paying them less than physicians and...more

The ERISA Litigation Newsletter - March 2016

Editor’s Overview - This month we review the U.S. Supreme Court’s decision in Montanile v. Board of Trustees of National Elevator Industries Health Benefit Plan where the Supreme Court considered the scope of...more

Time to Review Plan Subrogation Procedures, Part 2

I blogged a few days ago about the U.S. Supreme Court decision making it harder for plans to recover from a third-party settlement fund for the amount the plan paid when a participant is injured by that third-party. A recent...more

Enforcing Pay-to-Play Violations

I recently had an interesting dialogue with a city attorney in a pay-to-pay state about a new and – from the perspective of candidates everywhere – concerning state trend in pay-to-pay enforcement: mandatory candidate...more

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