On August 2, health care providers scored yet another significant victory when the US Court of Appeals for the Fifth Circuit affirmed the vacatur of various federal regulations regarding the arbitration procedures used to...more
8/8/2024
/ Arbitration ,
Arbitrators ,
Certiorari ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Final Rules ,
Health Care Providers ,
Insurance Industry ,
No Surprises Act (NSA) ,
Reimbursements ,
SCOTUS ,
U.S. Treasury
In a recent opinion, Smith et al. v. UnitedHealth Group Inc. et al., the US Court of Appeals for the Eighth Circuit affirmed the dismissal of an Employee Retirement Income Security Act (ERISA) class action suit brought by...more
On June 28, the US Supreme Court overturned the Chevron doctrine — the legal principle that the judiciary should defer to a federal agency’s reasonable interpretation of an ambiguous statute.
Chevron reflected the view...more
7/15/2024
/ Chevron Deference ,
Chevron v NRDC ,
Department of Health and Human Services (HHS) ,
Food and Drug Administration (FDA) ,
Healthcare ,
Hospitals ,
Judicial Review ,
Loper Bright Enterprises v Raimondo ,
Medicaid ,
Medicare ,
National Marine Fisheries Service ,
Regulatory Agenda ,
Reimbursements ,
Relentless Inc v US Department of Commerce ,
Rulemaking Process ,
SCOTUS
Change Healthcare, an affiliate of Optum and UnitedHealth Group, processes more than 15 billion health care transactions annually and touches one of every three patient records. On February 21, Change disconnected its...more
3/15/2024
/ American Medical Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Cyber Attacks ,
Cybersecurity ,
Health Care Providers ,
Healthcare ,
Insurance Industry ,
Medicare Part B ,
Payment Systems ,
Policies and Procedures ,
Popular ,
Prescription Drug Coverage ,
Prescription Drugs ,
Ransomware
On December 18, 2023, the US Departments of Treasury, Labor, and Health and Human Services (the Departments) issued a rule finalizing the 2024 non-refundable administrative fee parties must pay to access the arbitration...more
With the surge of interest in artificial intelligence (AI), it should be no surprise that health insurers have come under scrutiny concerning their use of AI predictive tools to deny medical insurance claims.
The question...more
12/22/2023
/ Algorithms ,
Artificial Intelligence ,
Automated Decision Systems (ADS) ,
Beneficiaries ,
Breach of Duty ,
CIGNA ,
Class Action ,
Health Care Providers ,
Health Insurance ,
Insurance Claims ,
Patients ,
United Healthcare Insurance Co.
*This is the 12th article in a series analyzing the No Surprises Act and its implementation. To view the entire series, click here. A link to the proposed rule is here. As background, Congress passed the Act to prevent...more
On September 21, 2023, the US Departments of Treasury (DOT), Labor (DOL), and Health and Human Services (HHS) (the Departments) issued new rulemaking governing the administrative fee required to access the arbitration process...more
10/4/2023
/ Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Fees ,
Final Rules ,
No Surprises Act (NSA) ,
Proposed Regulation ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
On August 24, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rulemaking under the federal No Surprises Act (the Act). This marked...more
On August 3, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rules governing fee collection and claim batching under the federal...more
8/22/2023
/ Administrative Procedure Act ,
Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Fees ,
Health Care Providers ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
In the year following the implementation of the arbitration process established under the federal No Surprises Act (NSA), more than 330,000 disputes have been submitted for resolution. This figure far outpaces the predictions...more
With the new year underway, the ArentFox Schiff Health Care team highlights 10 of the most pressing legal issues facing the industry in 2023.
End of the COVID-19 Public Health Emergency. After being in effect for more than...more
2/17/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Dobbs v. Jackson Women’s Health Organization ,
False Claims Act (FCA) ,
Federal Trade Commission (FTC) ,
Healthcare ,
HIPAA Privacy Rule ,
Inflation Reduction Act (IRA) ,
No Surprises Act (NSA) ,
Popular ,
Proposed Rules ,
Public Health Emergency ,
Reproductive Healthcare Issues ,
Roe v Wade ,
SCOTUS ,
Telehealth
- CMS estimates its proposal will result in a decrease of $320 million in Medicare Part A payments to skilled nursing facilities.
- CMS is seeking stakeholder input on the effects of direct-care staffing requirements for...more
Calling it a “straightforward inquiry,” the US Court of Appeals for the 11th Circuit recently opted to expand access to the Medicare Secondary Payer Act (the MSP Act) private right of recovery to Medicare Advantage...more
Below are six reimbursement issues that health care providers should be on “high alert” for as the COVID-19 crisis persists.
An increasing number of patients will be losing their health insurance coverage....more
On February 5, 2020, the Centers for Medicare and Medicaid Services (CMS) proposed removing long-standing prohibitions and eligibility restrictions that had barred many individuals with End-Stage Renal Disease (ESRD) from...more
2/11/2020
/ 21st Century Cures Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Eligibility ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Medicare ,
Medicare Advantage ,
Proposed Rules ,
Public Comment
On September 10, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a final rule with comment period, titled Program Integrity Enhancements to the Provider Enrollment Process (the “Final Rule”), which enhances...more
9/30/2019
/ Affiliates ,
Bad Actors ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Comment Period ,
Disclosure Requirements ,
Enforcement Authority ,
Enrollment ,
Final Rules ,
Health Care Providers ,
Medicaid ,
Medicare ,
Reporting Requirements