In October 2024, Blue Cross Blue Shield (“BCBS”) agreed to a $2.8 billion settlement to resolve allegations of anti-competitive practices in the health insurance market – it is reported to be the largest settlement in a...more
California is looking to take the lead on regulating private equity deals in the health care space by introducing bill AB 3129, which requires private equity groups or hedge funds to receive the state attorney general’s...more
Under the No Surprises Act, “open negotiation” is the period of time during which payers must disclose to providers important information regarding the claim at issue. On June 14, 2024, CMS announced a 120-calendar-day...more
7/11/2024
/ Attestation Requirements ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Care Providers ,
Healthcare ,
Negotiations ,
Surprise Medical Bills ,
U.S. Treasury ,
United Healthcare Insurance Co.
On April 23, 2024, the Federal Trade Commission (“FTC”) issued its final rule regarding noncompete clauses, and which determined that such clauses are an unfair method of competition and therefore violate section 5 of the...more
Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more
Last month, a cyberattack forced two New York hospitals to divert and even discharge some patients to other facilities, while the affected hospitals shut down their IT systems to address the issue and restore their secure...more
11/29/2023
/ Cyber Attacks ,
Cyber Incident Reporting ,
Cybersecurity ,
Data Breach ,
Electronic Medical Records ,
Healthcare Facilities ,
Hospitals ,
Multi-Factor Authentication ,
New York ,
Risk Assessment ,
Risk Management
On Friday, September 15th, the United States Attorney’s Office for the District of Massachusetts (United States) and the Massachusetts Attorney General’s Office (Massachusetts) filed a joint complaint in the United States...more
Prior authorizations, one of health insurers’ many “utilization management” techniques, is a hot topic amongst practicing physicians, patients, and regulators, to name a few. The prior-authorization process requires a health...more
On Friday, July 7, 2023, the Centers for Medicare & Medicaid Services (CMS) published their long-awaited proposed remedy to the unlawful 340B drug payment reductions.
Background: In 2018, CMS significantly reduced the...more