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Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Whiteford

Understanding Price Transparency Laws and Gag Clauses: A Guide for Healthcare Providers

Whiteford on

Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag...more

Kerr Russell

The Difference Between ‘Non-Covered’ vs. ‘Disallowed’ Services

Kerr Russell on

Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more

Rivkin Radler LLP

High-Profile Sports Insurance Fraud Rings: A Recent Conviction

Rivkin Radler LLP on

No health insurance benefit program, no matter how high profile, is immune to the temptations of insurance fraud. In the past, multiple former NFL players pleaded guilty to defrauding the NFL Player Health Reimbursement...more

Marshall Dennehey

Third District Court of Appeals Clarifies the Rules Surrounding Third-Party Intervention

Marshall Dennehey on

Accident911 Help Medical Center Corp., et al. v. Direct General Insurance Company, 3rd District, Case No, 3D23-773. L.T. Case No. 22-9836, Aug. 23, 2023 - The Third District Court of Appeal rules that the trial court abused...more

Steptoe & Johnson PLLC

The West Virginia Medical Professional Liability Act Applies Broadly to Services Encompassing Patient Care – Not Just the Care...

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The Supreme Court of Appeals of West Virginia issued a new opinion that finds that litigants cannot characterize claims as “corporate” or “general” negligence in an attempt to circumvent the West Virginia Medical Professional...more

Roetzel & Andress

Malpractice Insurance: What Providers Need to Know

Roetzel & Andress on

Roetzel health law attorneys and HealthLaw HotSpot co-hosts Ericka Adler and David Hochman are joined this week by Mike Madey, the vice president of business insurance at The Horton Group, in a discussion of malpractice...more

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