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Health Insurance Physicians

Sheppard Mullin Richter & Hampton LLP

So You Want to Start a Concierge Medicine Practice? Here are Five Key Legal Considerations

With increased consolidation of traditional medical practices and declining reimbursement rates, many physicians are turning to alternative models like concierge medicine to preserve their independence. Concierge medicine...more

Maynard Nexsen

Taking the Pulse, A Health Care and Life Sciences Video Podcast | Episode 244: The Future of Independent Physician Practices with...

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On episode 244, Lynnsey and Matthew are joined by Ray Waldrup, Co-Founder and CEO of The Leaders Rheum, a national network of leading rheumatology practices. Drawing on 3 decades of experience in healthcare leadership, Ray...more

Roetzel & Andress

One Big Beautiful Bill: A Boon for Concierge Medicine

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President Trump’s signing of the “One Big Beautiful Bill Act” on July 4, 2025, was a big win for concierge medicine practices, often called direct primary care (DPC). The new law allows favorable treatment for DPC...more

Jones Day

CMS Updates Kidney Care Choices Model

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The Center for Medicare and Medicaid Innovation ("CMMI") announced sweeping changes to the Kidney Care Choices Model ("KCC Model"), a key set of value-based programs....more

Davis Wright Tremaine LLP

Navigating Aetna's Expanded Claim Edits: What Providers Need To Know and Do Before September 1, 2025

Aetna recently announced that effective September 1, 2025, its Claim and Code Review Program (CCRP) will expand to include additional claim coding edits for all commercial, Medicare, and Student Health claims. While the...more

Arnall Golden Gregory LLP

Healthcare Providers Keep Singing the Blues About Unfair Reimbursement Rates But Blue Cross Blue Shield Won’t Change Its Tune

After more than a decade of litigation and more than $5 billion in settlements, the Blue Cross Blue Shield Association (“BCBSA”) and its affiliate insurance companies (the “BCBS Entities”) appear to be up to their old tricks....more

Arnall Golden Gregory LLP

Federal Court Permits MultiPlan Antitrust MDL to Proceed: Court Upholds Federal and State Antitrust and Consumer Protection...

On June 3, 2025, Judge Matthew F. Kennelly of the U.S. District Court for the Northern District of Illinois issued a sweeping ruling in In re MultiPlan Health Insurance Provider Litigation, largely denying motions to dismiss...more

Troutman Pepper Locke

California AG Takes Action Against $1.3 Million Insurance Fraud Scheme

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In May, California’s attorney general (AG) charged a local dermatologist with more than 20 counts of fraud after uncovering a scheme that allegedly resulted in the state’s Medicaid program paying out over $1.3 million for...more

ArentFox Schiff

Dispute Not Resolved: BCBSGA Sues Providers for Alleged Misuse of NSA Arbitration Process

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On May 27, Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (BCBSGA) filed a lawsuit in the Northern District of Georgia US District Court, alleging that a group of health care providers, along with their third-party...more

Foley & Lardner LLP

Risk Bearing Entity Requirements: Massachusetts

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This blog discusses the regulatory requirements that apply to risk-bearing entities in Massachusetts, including recent updates introduced by Chapter 343 of the Massachusetts Acts of 2024 (the Act). This blog is part of Foley...more

Hogan Lovells

AI Summit panelists offer tips for obtaining reimbursement for innovative health care technology

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Hogan Lovells and the AI Health Care Coalition recently hosted their fourth annual AI Health Law & Policy Summit, where thought leaders and policymakers gathered to discuss a variety of topics including reimbursement issues...more

Bass, Berry & Sims PLC

Indiana Enacts Legislation Affecting Health Care Transactions and Imposing Ownership Reporting Requirements

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On May 6, 2025, Indiana Governor Mike Braun signed Indiana HB 1666 into law. This new law grants Indiana’s attorney general authority to investigate market concentration of health care entities, modifies existing requirements...more

Pullman & Comley - Connecticut Health Law

Considering a Direct Primary Care Practice? Don’t Ignore State Law!

Our recent article in Physicians Practice outlines 10 Dos and Don’ts for physicians and other practitioners to take into account when deciding whether to establish a direct primary care (DPC) practice. ...more

Tarter Krinsky & Drogin LLP

New York Proposes Legislation to Provide Terminally Ill Persons a Medication to Peacefully End Their Life

Now Is the Right Time to Consult with Legal Counsel About Preparing Advance Directives that Reflect End-of-Life Wishes- New York’s Medical Aid in Dying Act (A136/S138) is once again before the New York State Legislature in...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

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Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

McDermott Will & Schulte

Trending in Telehealth March 2025

Trending in Telehealth highlights monthly state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and...more

Bass, Berry & Sims PLC

Healthcare Trends & Transactions Q1 2025

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The healthcare mergers and acquisitions (M&A) market began 2025 with a slower start than expected given the easing headwinds and building momentum at the end of last year, with the number of deals reported in Q1 lower than...more

Jones Day

CMS Innovation Center Announces Cost-Saving Restructuring of Value-Based Payment Model Portfolio

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The Center for Medicare and Medicaid Services ("CMS") has announced significant changes to its value-based payment model portfolio projected to save $750 million as part of a shift in the agency's refocused strategy toward...more

Hanson Bridgett

Peer Review by Licentiates Only: Beware Health Care Service Plans!

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On February 19, 2025, the California Court of Appeal published a decision, Lin v. Board of Directors of PrimeCare Medical Network, Inc., 108 Cal.App.5th 1163, emphasizing California Business and Professions Code’s requirement...more

Proskauer - Health Care Law Brief

DOH Issues Guidance on New York’s Material Health Care Transaction Law

Nearly two years ago, and as previously discussed in a Proskauer alert, New York enacted Public Health Law Article 45-A (the “Material Transactions Law”), which requires reporting of certain material health care transactions....more

Troutman Pepper Locke

Massachusetts AG Indicts Health Care Providers and Owners for Submission of Allegedly False Medicaid Claims

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The Office of Massachusetts Attorney General (AG) Andrea Campbell announced the criminal indictment of several Massachusetts-based health care providers and their owners in connection with allegedly false claims they...more

Dinsmore & Shohl LLP

Medicare Telehealth Flexibilities Extended, but Without Promise of Permanent Solution

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Through a recent stopgap funding bill, Congress has extended several telehealth-related flexibilities that are critical for Medicare beneficiaries and providers until September 30, 2025. As we previously reported, the...more

Polsinelli

HCPF Makes Clarifications to Mandatory Facility-Based Professionals’ Reporting Requirements Under Colorado Hospital Discounted...

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What is Colorado Hospital Discounted Care? Colorado’s Hospital Discounted Care law, effective September 1, 2022, brought a detailed and comprehensive yet highly confounding overhaul to the way hospitals, freestanding...more

Weber Gallagher Simpson Stapleton Fires &...

PA Supreme Court Approves OTC Supplements & CBD Oil for Workers’ Compensation

In a unanimous opinion issued today, the Pennsylvania Supreme Court has ruled that any item that is part of a health care provider’s treatment plan falls within the purview of medical services and the broad-encompassing...more

Benesch

Dialysis & Nephrology Digest - March 2025

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As Medicare physician reimbursement continues in 2025 to suffer from damaging shortfalls due to budget neutrality and lack of an inflation adjuster, steps are being taken in Congress to address the issue. On January 31, the...more

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