News & Analysis as of

Reimbursements

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

Fifth Circuit Holds That SPD Was An Enforceable Plan Document Through Which The Administrator Could Properly Seek Reimbursement

by DeWitt Law, LLC on

In another victory for plan administrators seeking reimbursement under the terms of ERISA plans, in Rhea v. Alan Ritchey, Inc. Welfare Benefit Plan, No. 16-41032, 2017 U.S. App. LEXIS 9482 (5th Cir. May 30, 2017), the Fifth...more

Fifth Circuit Enforces Reimbursement Provision in One-Page Welfare Plan

The Fifth Circuit upheld the reimbursement and subrogation terms found in a welfare benefit plan’s one-page SPD that also served as the plan document. Plaintiff, a plan beneficiary, received $71,644.77 from the plan to cover...more

Debt Dialogue: May 2017 - Fiduciary Duty of Collateral Manager Bars Side Deal to Recover Expenses

A typical collateralized debt financing involves a variety of service providers that owe fiduciary duties to investors. In a recent decision handed down in New York State Supreme Court, Commonwealth Advisors, Inc. v. Wells...more

Picking a Fight: How California Makes Employment Law Peculiar

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Our mission here at Cal-Pecs is to illuminate how California employment law differs from the law that employers generally experience throughout America. In this back-to-basics piece, we provide some...more

CMS Urged To Reverse Obama-Era Biosimilar Reimbursement Policy

A bipartisan congressional effort is underway to convince CMS to reverse its biosimilar reimbursement policy implemented under the Obama administration. We discussed the current reimbursement policy in a March 2016 blog post...more

Ninth Circuit Issues Shocking Opinion Concerning Health Care Provider ERISA Claims

The Ninth Circuit Court of Appeals is not known for being employer-friendly. So, when the Ninth Circuit issued its latest opinion on health care provider ERISA claims, most thought it would be against employer-sponsored...more

Is It Time To Recall Some Of Your HR Policies?

by Fisher Phillips on

Factory recalls have become a fact of life for those who sell and drive vehicles. The scenarios have a common theme: a vehicle part does not operate as designed or is determined to present a possible risk of failure. Once...more

Employee Business Expenses must be Ordinary and Necessary

by Foodman CPAs & Advisors on

Employees may be able to deduct their work related expenses as an itemized deduction. These expenses must be unreimbursed expenses that are ordinary and necessary to their work as an employee. According to IRS, an ordinary...more

Proving Utility, Demonstrating Value: How to Align the Moving Parts in Personalized Medicine Reimbursement

by Foley & Lardner LLP on

Of the many business, operational, legal, regulatory and clinical obstacles standing in the way of widespread delivery of personalized medicine, the single greatest challenge may lie in solving the reimbursement puzzle....more

Recovery of Medical Bills: Once Is Enough

by Faegre Baker Daniels on

Strange as it sounds, Missouri state law allowed federal workers to recover medical bills twice: once under their federal health insurance plan and again from the person (or person’s insurer) responsible for their injuries. ...more

The District of Oregon Rules That the United States May Not Pursue False Claims Act Litigation Against State Entities

by Hogan Lovells on

On April 11, 2017, the United States District Court for the District of Oregon held that the United States may not pursue False Claims Act (FCA) litigation against an arm of the State and dismissed the FCA claims in the...more

Structuring A Parking Reimbursement Plan As A Taxable Or Tax-Free Fringe Benefit

by Dickinson Wright on

In Information Letter 2017-0007, the IRS analyzed an employer’s parking reimbursement arrangement and concluded that it was not a tax-free fringe benefit. ...more

Medicare Plans Sue Auto Insurers for Illegal Cost Shifting

by Faegre Baker Daniels on

When Medicare beneficiaries are taken to the ER after an auto accident, they’re likely to have their Medicare cards with them, but not their auto policies. This creates a problem for Medicare because Medicare is supposed to...more

Health Care Providers Should Review Assignment of Benefit Forms After 9th Cir. Decision

by Pepper Hamilton LLP on

A federal appeals court recently brushed aside the claims of several health care providers, in large part because of the language in the assignment forms signed by their patients. The opinion from the U.S. Court of Appeals...more

The Telehealth Cost Wars

by Cozen O'Connor on

How to properly evaluate and weigh cost savings in health care has long been a controversial subject—perhaps nowhere more so than when technology-enabled health care is evaluated. A recent study is a case in point. The...more

February 2017 Protest Roundup

In February 2017, the Government Accountability Office (GAO) publicly released notable decisions addressing (1) the effect of the temporary lapse in GAO’s civilian task order jurisdiction; (2) discussions, clarifications, and...more

Laws and Regulations Affecting Government Contractors

by Polsinelli on

Government contractors wondering whether and when they can protest military and civilian task and delivery orders should be aware of recent changes in the law affecting a party’s right to protest before the General...more

OIG Publishes Online Portfolio Highlighting its Body of Work on Drug Pricing and Reimbursement

For several years now, the public outcry over the issue of drug pricing and reimbursement has increased in frequency and fervor. At least one government agency wants you to know that it has been listening and wants to help...more

Noodle This! The Yin and Yang of Two Courts, Two Antitrust Cases, Two Class Certification Motions, Two Daubert Challenges, Two...

by Carlton Fields on

Noodle this: Two significant orders on class certification in antitrust matters issued last week. Both were heavily influenced by the threshold determination of Daubert challenges to the plaintiffs’ expert evidence. In one...more

11th Circuit Affirms Decision that Insurer Is Not Estopped from Denying Pre-Tender Costs

In EmbroidMe.com, Inc. v. Travelers Prop. Cas. Co. of Am., No. 14-10616, 2017 U.S. App. LEXIS 368 (11th Cir. Jan. 9, 2017), the Eleventh Circuit had occasion to consider whether an insurer had an obligation to reimburse its...more

Members of Ophthalmologist Group Charged with Illegal Boycott of Health Plan

by Mintz Levin on

An ophthalmologist cooperative in Puerto Rico settled charges with the Federal Trade Commission (“FTC”) last week that it orchestrated an illegal boycott of a health plan. The FTC alleged that the cooperative urged its...more

New Initiatives for the New Year: Highlights of the OIG’s 2017 Work Plan

by Alston & Bird on

On November 10, 2016, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its 2017 Work Plan. The 2017 Work Plan outlines the areas of special concern to the OIG and...more

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