Apparently in light of recent litigation against Medicare Advantage (MA) plans, on February 6, 2024, CMS published responses to frequently asked questions (FAQs) regarding the use of algorithms and artificial intelligence in...more
2/22/2024
/ Algorithms ,
Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
Discrimination ,
Disparate Impact ,
Eligibility Determination ,
Health Insurance ,
Healthcare ,
Medicare ,
Medicare Advantage ,
Popular
Three years after the No Surprises Act (NSA) was enacted, industry stakeholders and government regulators alike are still navigating the intricate twists and turns of the wide-ranging legislation’s key provisions. In a new...more
The No Surprises Act (NSA), which went into effect January 1, 2022, was designed to protect patients from surprise medical bills when they are treated in out-of-network emergency departments or by out-of-network providers at...more
2/2/2023
/ Arbitration ,
Arbitrators ,
Continuing Legal Education ,
Dispute Resolution ,
Enforcement Actions ,
Explanation of Benefits (EOBs) ,
Health Care Providers ,
Health Insurance ,
Insurance Litigation ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Surprise Medical Bills ,
Webinars
On November 4 and 7, 2022, the California Department of Managed Health Care (DMHC) issued two All Plan Letters (APL 22-026 and APL 22-027) concerning compliance with the state’s network adequacy and timely access...more
The Big Picture -
The Biden Administration released an interim final rule with comment period (IFC) on September 30 that answers an important remaining question under the No Surprises Act (NSA): How will the amount that...more
10/18/2021
/ Biden Administration ,
Comment Period ,
Consolidated Appropriations Act (CAA) ,
Dispute Resolution ,
Good Faith ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Interim Final Rules (IFR) ,
Out of Network Provider ,
Out-of-Pocket Expenses ,
Surprise Medical Bills
On August 3, 2020, the California Supreme Court held in Ixchel Pharma, LLC v. Biogen, Inc. that tortious interference with at-will contracts requires establishing wrongful conduct independent of interference itself. 9 Cal....more
On October 1, 2018, the U.S. Supreme Court denied a petition for a writ of certiorari asking the Court to weigh in on just how precisely a whistleblower must plead the submission of a false claim. Since the False Claims Act...more
Part 1: Megatrends Reinventing How Patients Think -
Editor’s Note: In a recent webinar for PharmaVOICE, Manatt Health revealed the megatrends reinventing the life sciences industry—and how they relate to new thinking by...more