Certain provisions of the recent CARES Act impact how hospitals are reimbursed under original Fee-For-Service Medicare (i.e., Part A and Part B) and existing Medicare Advantage contracts. Specifically, the CARES Act...more
In this episode, Gary Qualls discusses a recent development in payer litigation which implicates a number of recurring issues often raised in Employee Retirement Income Security Act (ERISA) cases. Specifically, a federal...more
2/7/2019
/ Administrative Remedies ,
Anti-Assignment Clauses ,
Assignment of Benefits (AOB) ,
Breach of Duty ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Motion to Dismiss ,
Patients ,
Payor Contracts ,
Plan Administrators ,
Preemption
In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments pursuant to a Medicare Advantage contract. Specifically, a recent federal case...more
7/26/2018
/ Administrative Appeals ,
Administrative Remedies ,
Breach of Contract ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Insurer Liability ,
Jurisdiction ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Patients ,
Payor Contracts ,
Preemption ,
State Law Claims ,
Underpayment
Recently, the North Carolina Court of Appeals confirmed the state’s statutory peer review privilege by holding that documents produced or considered by a hospital’s Medical Review Committee (“MRC”) were protected from...more