In July 2019, Judge Gilliam of the Northern District of California issued an order interpreting the different avenues a plaintiff may pursue in bringing a parity claim—a decision that may be consequential to health plans and...more
Editor’s Note: The article below provides an update on the risk corridors program (Program) created by the Patient Protection and Affordable Care Act (ACA). The Program was intended to encourage qualified health plan (QHP)...more
On May 1, 2018, the U.S. Departments of Labor, Health & Human Services and the Treasury (Departments) clarified the Patient Protection and Affordable Care Act’s (ACA) “greatest-of-three” regulation (GOT regulation) in...more
On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Health & Human Services (HHS) Notice of Benefit and Payment Parameters for 2019 (final rule). The final rule is the first time the Trump...more
Mental Health and Minors: Proceed With Caution! -
Imagine representing a party in a lawsuit concerning coverage for mental health services. The lawsuit was brought by the parents of a minor child. The client received a...more
Fraud and Abuse 2017: Understanding Trends and Avoiding Actions -
Editor’s Note: In a recent webinar for Bloomberg BNA, Manatt examined game-changing fraud and abuse trends and cases—and revealed strategies for avoiding...more
11/27/2017
/ Affordable Care Act ,
Anti-Kickback Statute ,
Antitrust Division ,
Caronia ,
Centers for Medicare & Medicaid Services (CMS) ,
Digital Health ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Foreign Corrupt Practices Act (FCPA) ,
Fraud ,
Healthcare Fraud ,
Hospitals ,
Opioid ,
REMS ,
Universal Health Services Inc v United States ex rel Escobar
Health insurers may have experienced uncertainty in 2017 when they were setting 2018 rates for individual plans sold on federal and state exchanges pursuant to the Affordable Care Act (ACA). One reason may have been the...more
Mapping the Healthcare M&A Landscape Under the New Administration -
Editor’s Note: The healthcare M&A market continues to be among the most active sectors. In a recent webinar, Manatt examined how the policies and goals of...more
5/25/2017
/ Acquisitions ,
Affordable Care Act ,
American Health Care Act (AHCA) ,
Antitrust Provisions ,
Centers for Medicare & Medicaid Services (CMS) ,
DSH ,
Food and Drug Administration (FDA) ,
Health Insurance ,
Healthcare Reform ,
Hospitals ,
Mergers ,
Trump Administration
Since the passage of the Affordable Care Act (ACA), the payment of healthcare premiums by third parties has been the subject of controversy. As Congress develops its plan to repeal and replace the ACA, it is uncertain how...more
The Future of Essential Health Benefits -
Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more
3/24/2017
/ Affordable Care Act ,
Antitrust Immunity ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Essential Health Benefits ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Reform ,
Insurer Liability ,
Medicaid ,
Premiums ,
Repeal ,
Trump Administration
Defining and Resolving the Provider Data Dilemma -
Editor’s Note: Provider data drives the most fundamental processes in the healthcare system. Inaccurate provider data puts patient care and billions of dollars at risk....more
10/21/2016
/ Affordable Care Act ,
Bipartisan Budget ,
Consumer Privacy Bill of Rights ,
Data-Sharing ,
Dispute Resolution ,
DSRIP ,
Federal Trade Commission (FTC) ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Hospital Mergers ,
Mexico ,
Personal Data ,
Private Sector ,
Public Policy ,
Public Service Commissions ,
Social Media ,
Value-Based Payments
The Vulnerability of Healthcare Information -
According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more
7/28/2016
/ Abortion ,
Affordable Care Act ,
Anti-Steering Rules ,
Antitrust Violations ,
Attorney's Fees ,
Bad Faith ,
Brandt Fees ,
Children's Health Insurance Program (CHIP) ,
Compensatory Damages ,
Contraceptive Coverage Mandate ,
Cybersecurity ,
Data Protection ,
Denial of Benefits ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
Employee Retirement Income Security Act (ERISA) ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Trade Commission (FTC) ,
Food and Drug Administration (FDA) ,
Gobeille v Liberty Mutual Insurance Com. ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Justice Scalia ,
Market Power ,
Materiality ,
Medicaid ,
Medical Devices ,
Medicare ,
Nurses ,
OCR ,
Patient Privacy Rights ,
PHI ,
Preemption ,
Punitive Damages ,
Religious Institutions ,
Right to Privacy ,
SCOTUS ,
Undue Burden ,
Universal Health Services Inc v United States ex rel Escobar ,
Wearable Technology ,
Whole Woman's Health v Hellerstedt ,
Zubik v Burwell
Real-Time Data Analytics in Government Investigations and Reducing Exposure -
It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more
6/24/2016
/ ACOs ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Government Investigations ,
Healthcare Fraud ,
HEAT ,
Hospital Mergers ,
IRS ,
MCOs ,
Medi-Cal ,
Medicaid ,
Medicare Advantage ,
OIG ,
Section 340B