News & Analysis as of

Health Insurance

Beware: IRS To Begin Issuing ACA Employer Shared Responsibility Payment Penalty Notices

The IRS has announced its next steps regarding the Employer Shared Responsibility Payments (the “ESRPs”), which are the ACA penalties assessable to “Applicable Large Employers” for failing to provide affordable health care...more

Opioid Litigation Over Insurance Coverage – Coming to a Jurisdiction Near You

by Nexsen Pruet, PLLC on

A very recent appellate ruling in California provides a roadmap for opioid litigation over insurance coverage that is about to ramp up all over country. In Travelers Prop. Cas. Co. of Am. v. Actavis, Inc. et al, 2017 WL...more

The Art of Reduction: OPEB Costs, Commitments

by Best Best & Krieger LLP on

California’s gap between promised employee benefits and available cash is wide and ever expanding. Ballooning pension costs and rising deficits are often in the spotlight. But commitments that California’s governing bodies...more

Federal Tax Reform: The Current State of Play & The Big Picture (Updated 11/16)

by Ballard Spahr LLP on

The Senate Finance Committee released a detailed description of the Senate's tax reform bill, titled the Tax Cuts and Jobs Act, on November 9. The Committee has not released the text of the bill, and likely will not do so...more

2019 Notice of Benefit and Payment Parameters

On October 27, 2017, the Department of Health and Human Services (HHS) released its annual proposed Notice of Benefit and Payment Parameters, containing proposed changes to the regulation of the individual and small group...more

The Opioid Epidemic: Are We Headed Toward a Tipping Point?

by Burr & Forman on

Health care law and policy occupy a prime place in the current news cycle. Much of the attention revolves around the actions or inactions of Congress and the White House, particularly with regard to their impact on the future...more

Labor Secretary Discusses DOL Priorities During House Committee Hearing

by Littler on

Labor Secretary Alexander Acosta fielded a range of questions on the DOL's priorities during a November 15 hearing before the House Committee on Education and the Workforce. Although members of the Committee inquired about...more

Obamacare Fight Spurs Executive Actions and Legislative Proposal

by Burr & Forman on

The last 30 days have seen efforts by both the executive and legislative branches to improve conditions in the health care insurance markets with the goal of making health insurance more accessible and affordable. Please...more

Fourth Circuit Affirms Health Care Fraud Convictions for Billing Insurers for Medically Unnecessary Services

by Seyfarth Shaw LLP on

Seyfarth Synopsis: The Fourth Circuit found that the medical necessity of a given service constitutes a material element of representations regarding submissions for payment, potentially providing payors with another legal...more

Three Years Later, Foley Survey Reveals Positive Prognosis for Telemedicine

by Foley & Lardner LLP on

When we launched Foley’s inaugural Telemedicine and Digital Health Survey in 2014, it was apparent that health care executives weren’t ready to make telemedicine a significant focus of their business and patient strategies....more

IRS Prepares to Enforce ACA Employer Mandate

by Ballard Spahr LLP on

The IRS has announced its intent to begin enforcing the employer-shared responsibility provisions (otherwise known as the employer mandate or pay-or-play provisions) of the Affordable Care Act for the 2015 calendar year....more

Issue 115: Ready or Not, Here Come ACA Employer Mandate Penalty Notices

by Seyfarth Shaw LLP on

This is the one hundred and fifteenth issue in our series of alerts for employers on selected topics on health care reform. This series of Health Care Reform Management Alerts is designed to provide an in-depth analysis of...more

Medicaid Fraud Whistleblower Loses Bid To Keep His Name Out Of The Public Eye

by Farrell Fritz, P.C. on

False Claims Act whistleblowers expose themselves to significant risks by coming forward and asserting claims of fraud against the government. Often, the whistleblowers, called relators under the False Claims Act, would...more

Short-Term Disability Denial for Gender Reassignment

by Bowditch & Dewey on

In Baker v. Aetna, (U.S. Northern District Court of Texas, 2017), Charlize Marie Baker filed claims against her employer and Aetna after having been denied benefits under the health plan and the short-term disability plan for...more

Window on Washington - Vol. 1, Issue 34

by Clark Hill PLC on

Short-term Continuing Resolution Likely Needed to Fund Government Past December Deadline: Republicans are focused on tax reform through Thanksgiving, and when lawmakers return from the upcoming holiday recess, they will have...more

A Question of Privilege: Court Wrestles With Attorney-Client and Work Product Issues in Data Breach Case

In a significant ruling addressing the scope of the attorney-client privilege and work product doctrine in a data breach case, a Federal judge in Oregon ordered Premera Blue Cross, the Washington-based healthcare services...more

Under The Dome: Inside The Maine State House

by Pierce Atwood LLP on

Legislature Sustains Governor's Veto of Marijuana Implementation Legislation - On Monday, November 6, the Legislature met for the second day of the Special Session to take up the Governor’s veto of the marijuana...more

Update: HHS Announces Two Additional Medicare Appeals Settlement Initiatives

by Polsinelli on

On Nov. 3, Health & Human Services (HHS) announced two additional initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge (ALJ) level: (i) expand the Settlement Conference Facilitation...more

Humana Bundles Up; Files Suit To Recover Hundreds Of Millions In Risk Corridor Payments From Uncle Sam

by Carlton Fields on

On November 2, Humana filed a lawsuit in the United States Court of Federal Claims to recover approximately $600 million allegedly owed by the United States government. See Humana Inc. v. U.S., case number 1:17-cv-01664. ...more

Health Care Newsmakers: Steve McCoy, Vice President/General Counsel, Patient First

by Williams Mullen on

With all the discussion lately about trying to manage the cost of healthcare, what are the most important recent changes in reimbursement methodology and strategies which Patient First has seen in the market? The ongoing...more

Health Alert (Australia) 30 October 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: New South Wales 20 October 2017 - Quach v New South Wales Health Care Complaints Commission; Quach v New South Wales Civil and...more

Capitol Hill Healthcare Update

by BakerHostetler on

The House last week voted to renew the Children’s Health Insurance Program (CHIP) through 2022, but disagreements over how to pay for the program are likely to delay consideration in the Senate beyond this month. On a...more

Issue 114: Relief from HIPAA Certification Requirement

by Seyfarth Shaw LLP on

This is the one hundred and fourteenth issue in our series of alerts for employers on selected topics on health care reform. This series of Health Care Reform Management Alerts is designed to provide an in-depth analysis of...more

Beltway Buzz - November, 2017

House Republicans Release Long-Awaited Tax Package. On Thursday, November 2, House Republicans released the legislative text of their eagerly awaited tax reform bill....more

IRS Pressing Forward With ACA Penalties

Yesterday, the IRS reiterated that employers violating the ACA can expect penalty letters in late 2017 and also updated that portion of its website dedicated to the Employers’ ACA obligations. The update explains the form of...more

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