News & Analysis as of

Reimbursements

Phase One Of Grubhub Trial Ends; Waiting Game Begins

by Fisher Phillips on

The evidentiary phase of the Grubhub misclassification trial ended last week; now the gig economy world waits with baited breath for a final ruling. For those unfamiliar with the situation, this could be the first time the...more

THE LATEST: Washington Attorney General Seeks Disgorgement of Profits Resulting from Two Transactions between Health System and...

by McDermott Will & Emery on

On August 31, 2017, the Attorney General of Washington filed a complaint in the United States District Court for the Western District of Washington alleging that two transactions harmed competition for healthcare on the...more

New Light on Legal Fees in Stay-Put Battle

by Barley Snyder on

Parents of students attending a private school as a pendent placement during “stay- put” have been entitled to receive tuition reimbursement through the end of the appeals process. Now, according to the Third Circuit Court...more

Court Instructs Federal Agencies to Re-Examine Their Response to Comments Regarding Out-of-Network Emergency Services...

by King & Spalding on

On August 31, 2017, the U.S. District Court for the District of Columbia held that HHS, the Department of Labor and the Department of Treasury (the Departments) failed to adequately address commenters’ concerns and proposed...more

California Supreme Court Confirms that PAGA Plaintiffs Are Entitled to Broad Discovery of Other Employees’ Contact Information

by Foley & Lardner LLP on

California’s Private Attorneys General Act (PAGA) allows aggrieved employees to recover civil penalties on behalf of themselves, other employees, and the State of California for Labor Code violations. On July 13, 2017, the...more

Telehealth Parity Laws: The Real Story

by Cozen O'Connor on

State telehealth parity laws, which generally require private payers (and occasionally Medicaid programs) to cover telehealth services if those services would be covered if provided in-person, have long been trumpeted as a...more

CMS Proposes Reimbursement Cuts for Certain Hospital Provider-Based Departments

by McGuireWoods LLP on

Non-excepted hospital off-campus provider-based departments (PBDs) may once again face cuts to reimbursement during calendar year 2018 (CY 2018) if the Centers for Medicare & Medicaid Services (CMS) finalizes proposed changes...more

K&L Gates Triage: 340B Eligibility - Hospital Covered Entities

by K&L Gates LLP on

This podcast focuses on the eligibility requirements for hospitals participating in the 340B Drug Pricing Program. Factors affecting eligibility include a hospital’s licensure status, patient population, and Medicare...more

Recent 11th Circuit Decision Is a Victory for Health Care Providers Challenging Insurer Reimbursement Decisions and a Reminder of...

by K&L Gates LLP on

The existence and scope of assignments of benefits from patients to health care providers continues to be critically important to a provider’s ability to challenge an insurer’s reimbursement decision under the Employee...more

340B Covered Entities Beware: CMS Proposes Drastic Drug Reimbursement Rate Cuts

by Polsinelli on

In its Outpatient Prospective Payment System proposed rule ("Proposed Rule"), CMS outlined a significant Medicare Part B payment reduction for separately payable, nonpassthrough drugs provided in the hospital outpatient...more

Disparagement Allegations May Trigger Valuable Coverage

A recent case we handled highlights the importance of reading a complaint’s allegations very carefully. Competitors in high-stakes litigation may file complaints and cross-complaints against each other alleging a variety of...more

IRS Encourages Self-Assessment to Identify Fringe Benefit Errors

by Ruder Ware on

As much as I love tax law, filling out another tax form isn’t high on my list of fun things to do. So when the IRS issues a form that isn’t legally required to complete, should you? If you are an employer that provides one or...more

CMS’s 340B Proposal Is Likely Unlawful—Here’s Why

by Morgan Lewis on

The agency’s recent proposal to reduce certain drug reimbursement is unprecedented and not based on a reasonable interpretation of its statutory authority....more

Court Grants Most of Plaintiff’s Cost Recovery Request, Including All eDiscovery Costs: eDiscovery Case Week

by CloudNine on

In Ariel Inv., LLC v. Ariel Capital Advisors LLC, No. 15 C 3717 (N.D. Ill., July 17, 2017), Illinois District Judge Matthew F. Kennelly granted the prevailing plaintiff’s request to tax most requested costs in the amount of...more

ECJ: Clarification on Withdrawing State Aid from Companies Deemed "Undertaking in Difficulty"

by Jones Day on

The notion of "undertaking in difficulty" is a key element in State aid law because undertakings in difficulty can receive State aid only under the restrictive conditions for so-called rescue and restructuring aid. Any other...more

Ninth Circuit Relies on Escobar to Revive False Claims Act Suit Against Pharmaceutical Manufacturer

On July 7, 2017, the U.S. Court of Appeals for the Ninth Circuit reversed a federal district court’s dismissal of a False Claims Act (FCA) whistleblower suit in United States ex rel. Campie v. Gilead Sciences, explaining that...more

Ninth Circuit Relies on Escobar to Revive False Claims Act Suit Against Pharmaceutical Manufacturer

On July 7, 2017, the U.S. Court of Appeals for the Ninth Circuit reversed a federal district court’s dismissal of a False Claims Act (FCA) whistleblower suit in United States ex rel. Campie v. Gilead Sciences, explaining that...more

Arrangement Fee Clauses in German Loan Agreements ruled invalid by German Federal Court

by Dechert LLP on

The German Federal Court issued a series of groundbreaking rulings on July 4, 2017. Arrangement fee clauses in German law loan agreements are invalid if they are included in general terms and conditions set by the lender....more

Updated Health Care Reform Legislation Comparison Chart

The chart below compares key provisions of the Affordable Care Act (ACA), the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). This chart is current as of July 13, 2017, and as of that date,...more

Key funding issues for provider-operated allied health residency programs

by Dentons on

Medicare GME reimbursement is designed only to support the training of medical, dental and podiatric residents. The Medicare program does, however, provide separate funding to support certain programs that train nursing and...more

The Ultimate Misclassification Showdown Could Be Right Around The Corner

by Fisher Phillips on

Gig employers returning from the Fourth of July holiday were in for a rude awakening when they learned about the fireworks that just went down in a California federal court. Right before the holiday weekend, Judge Jacqueline...more

Court of Milan rules on interim measure ordering the halt of the pricing and reimbursement procedure of a generic product

by Hogan Lovells on

By order issued on June 18, 2017, in summary proceedings brought by Teva against Mylan and Synthon for the alleged infringement of EP 2 361 924 (covering a manufacturing process for the active ingredient glatiramer acetate),...more

Value-based health care: fraud & abuse laws

by Ropes & Gray LLP on

Michael Lampert, Ropes & Gray health care partner, discusses fraud and abuse law application to value-based health care arrangements. __ Much has been made about how the fraud and abuse laws, which were designed in order...more

The Uber Board Report – Part II: Internal Controls

by Thomas Fox on

I continue my blog post series on the Holder Report (Report) to the Board of Directors of Uber Technology, Inc. (Uber) where the Board asked Holder’s law firm, Covington & Burling LLP (Covington), to evaluate three issues:...more

Value-based health care: issues for pharmaceutical companies

by Ropes & Gray LLP on

Michael Lampert, Ropes & Gray health care partner, discusses issues facing pharmaceutical companies with the move towards value-based health care models. __ When I think about developing a value-based program for...more

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