Reimbursements

News & Analysis as of

The Ping FCPA Enforcement Action: Lessons for the Compliance Practitioner

The Securities and Exchange Commission (SEC) settled a Foreign Corrupt Practices Act (FCPA) enforcement action against an individual earlier this month when it announced the resolution of a matter involving Jun Ping Zhang,...more

News from Second and State

Yesterday was the first day of fall, and it seems the summer is truly behind us. The House of Representatives reconvened this week for the final stretch of the 2015-2016 legislative session. This week most of the action...more

The Limited Applicability of the Severin Doctrine

A recent Armed Services Board of Contract Appeals (ASBCA) decision discusses the Severin doctrine and its impact on subcontractor pass-through claims, confirming that this defense to liability may only be used in very limited...more

California Joins New York and Florida, Passes Out-Of-Network Legislation

Last month the California legislature passed AB-72, which amends the Health & Safety Code to address reimbursement for out of network (OON) providers who provide services at in-network facilities, such as hospitals and...more

Sixth Circuit Vacates Class Settlement, Finding that Sealed Documents Prevented Objectors from Assessing Settlement’s Fairness

This summer, the Sixth Circuit rejected class action litigants’ filing of the bulk of their class settlement documents under seal. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., 825 F.3d 299 (6th Cir. 2016). The Sixth...more

Obstruction of a Medicare Audit Doesn’t Require Direct Obstruction of a Federal Agent

A registered pharmacist, the owner of two Alabama pharmacies, pleaded guilty to obstructing a 2012 federal audit of Medicare claims and agreed to pay a $2.5 million penalty to the government. The submission of the false and...more

California Physician Loses at Dating Game

A California appellate court has declared physician Visha Dev the loser in his dating contest with Blue Shield Life and Blue Shield California. The contest arose when the Blues moved for summary judgment in Dev’s action...more

GAO, OIG Issue Reports on Medicare Part B Drug Payment Issues

The HHS Office of Inspector General (OIG) and the Government Accountability Office (GAO) recently issued several reports on various Medicare Part B drug reimbursement issues. In a report entitled “Medicare Part B: Data on...more

Sixth Circuit Denies Seal of Approval for Unjustified Filings Under Seal

Litigants and third parties subpoenaed to produce information in litigation who believe that information that they deem confidential will not ever become part of the public record so long as a discovery protective order is in...more

IRS Publishes New Management Contract Safe Harbors for Property Financed with Tax-Exempt Bonds

On August 22, 2016, the Internal Revenue Service (IRS) released Rev. Proc. 2016-44, which provides new guidance on the treatment of “management contracts” for purposes of the restrictions on use of property financed with...more

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

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