News & Analysis as of

Health Insurance

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

Clean Up on Aisle 12! The Obamacare Pop-Up Store is Open but Stocks are Limited

The fifth Open Enrollment period under the Affordable Care Act (ACA) started on November 1st, and will continue for a scant 45 days ending on December 15, 2017. This year, not only has the Open Enrollment been cut in half,...more

Recent Developments in Antitrust Scrutiny of Healthcare-Provider Transactions

by Holland & Knight LLP on

As the trend of acquisitions of physician practices and mergers of hospitals continues, so does antitrust scrutiny of these deals. There was activity this week in three different proposed transactions that caught the...more

California’s Departments of Managed Health Care and Insurance Publish Their Processes For Resolving Reimbursement Disputes Between...

by King & Spalding on

This bulletin is a follow-up to the August, 2017 King & Spalding Client Alert, “California’s Surprising New ‘No Surprise’ Health Care Billing Law” (“August Alert”). As described in our August Alert, California’s new “No...more

21st Century Cures Act Qualified Small Employer Health Reimbursement Arrangements (“QSEHRAs”) May Not Be the Total Cure

by Winstead PC on

QSEHRAs are designed for employers that are not applicable large employers under the employer shared responsibility tax (Code section 4980H). QSEHRAs may only be offered by employers with fewer than 50 full-time employees (as...more

On-Site Clinics: What Effect On HDHPs And HSAs?

by Jackson Lewis P.C. on

As of October 2017, Health Care Still Uncertain. We already know the state of health care in the United States continues to whipsaw, as an October 25th ruling demonstrates: a federal district court confirmed that the Trump...more

Alternative to Affordable Care Act Congressional Repeal and Replace: Executive Branch Action

by McGuireWoods LLP on

As part of the executive branch’s ongoing efforts to peel back portions of the Patient Protection and Affordable Care Act of 2010 and its companion statute, the Health Care and Education Reconciliation Act of 2010 (referred...more

A Step Toward ‘Replace' Without the ‘Repeal': The Trump Administration Re-Regulates Obamacare

by Faegre Baker Daniels on

On Friday, October 27, the Centers for Medicare and Medicaid Services (CMS) published its draft annual Proposed Notice of Benefits and Payment Parameters for Calendar Year 2019. This proposal follows on the heels of a Request...more

Update #10: Trump Administration Halts Funding of Cost Sharing Reduction Payments to Insurers

by Davis Wright Tremaine LLP on

Earlier in October, the Trump Administration announced it would immediately terminate payments to insurers to offset the costs of ACA-mandated discounts on co-payments and deductibles for low-income consumers. A number of...more

Treasury Announces 2017-2018 Regulatory Agenda for Employee Benefits

The Internal Revenue Service (IRS) has recently published updates to its guidance plans for the coming months. - On October 20, 2017, the US Department of the Treasury and the IRS released their 2017-2018 Priority Guidance...more

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