News & Analysis as of

Healthcare Facilities Insurance Industry

King & Spalding

Aetna Policy Attempts to Circumvent Two Midnight Rule for MA Plans

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In a recent Aetna newsletter update (also referred to as OfficeLink), Aetna advised that it would change its reimbursement approach for emergent or urgent inpatient stays that span at least one midnight at facilities that...more

BakerHostetler

Alive and (Anti)Kicking: EKRA Prosecutions on the Rise in California with Multiple Recent Indictments

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In the past few months, federal prosecutors in California have brought multiple indictments under the Eliminating Kickbacks in Recovery Act (EKRA) charging the owners of substance abuse treatment facilities and their...more

Jackson Walker

Senate Bill (SB) 2544: Mediation Filing Deadlines for Out-Of-Network Facilities

Jackson Walker on

The recently enacted Texas Senate Bill (SB) 2544 imposes mandatory mediation filing deadlines for out-of-network (OON) facility providers. Under Insurance Code Chapter 1467, OON facility providers (including ambulatory...more

Maynard Nexsen

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

Maynard Nexsen on

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

Wiley Rein LLP

Colorado Court of Appeals Permits COVID-19 Coverage Suit to Proceed Based on Health Care Endorsement Coverage

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The Colorado Court of Appeals (Division VI), applying Colorado law, partially affirmed a trial court decision dismissing an action seeking insurance coverage for COVID‑19 related losses. Spectrum Retirement Communities, LLC...more

J.S. Held

All Is Not What It Seems, Or When Is A Dollar A Dime?

J.S. Held on

Welcome to the strange and mysterious world of medical billing. If ever there was an industry in which the charges and the payments have no correlation, the medical industry is it. Medical billing can indeed be quite...more

Arnall Golden Gregory LLP

OIG Approves Arrangement Incentivizing Medigap Policyholders to Seek Treatment From PHO Network Hospitals

The Department of Health and Human Services, Office of Inspector General (“OIG”) recently released a favorable advisory opinion, OIG Advisory Opinion No. 24-01 (the “Opinion”), to a Medicare Supplemental Health Insurance...more

Hinshaw & Culbertson - Privacy, Cyber & AI...

A Surge in Illinois Genetic Information Privacy Act (GIPA) Claims Poses Threat to Employers

The Illinois Genetic Information Privacy Act (“GIPA”) was enacted in 1998, and although minimal litigation followed in the years following its enaction, we are now seeing a significant surge in litigation similar to that...more

Hall Benefits Law

Lawsuit Claims UnitedHealthcare Uses AI to Deny Majority of Medicare Advantage Extended-Care Facility Claims

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As the healthcare industry has begun to use artificial intelligence (AI) algorithms in its claims determination process, litigation has ensued. In a recent class action lawsuit, plaintiffs claim that UnitedHealthcare used its...more

Wiley Rein LLP

Insurer Entitled to Rescission for Insured’s Misrepresentations on Renewal Application

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The United States District Court for the Central District of California, applying California law, has held that an insurer was entitled to rescind a professional liability policy issued to a healthcare facility because the...more

Wiley Rein LLP

Multiple Claims Against Insured Related to COVID-19 Outbreak Constitute Separate Claims

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The United States District Court for the Eastern District of Pennsylvania, applying Pennsylvania law, has held that multiple COVID-19 claims against an insured arise from separate “health care events” such that they...more

Wiley Rein LLP

Professional Services Exclusion Does Not Bar Coverage for Lawsuit Alleging “Business Decisions” of Healthcare Facility

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The United States District Court for the Southern District of Florida, applying Maryland law, has held that the professional services and managed care activity exclusions in a D&O policy did not bar coverage for a lawsuit...more

Foley & Lardner LLP

Behavioral Health & Substance Abuse Services: Massachusetts Proposal Reflects Focus on Expanding Access and Coverage

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... Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require...more

Sheppard Mullin Richter & Hampton LLP

Surprise Billing Initiatives Face Not-So-Surprising Resistance

“Surprise billing,” also known as “balance billing,” is one of few areas that garners bipartisan support. Surprise billing occurs when a patient inadvertently goes out of his or her insurer’s network, resulting in a “surprise...more

Foley & Lardner LLP

Massachusetts Governor Proposes Facility Fee Ban

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Massachusetts Governor Charlie Baker has restarted the discussion on health care cost containment in the Commonwealth with a proposed bill that contains a raft of initiatives. This is the first in a series of blog posts to...more

K&L Gates LLP

HHS Proposes Rules for Nondiscrimination in Health Care

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On September 8, 2015, the U.S. Department of Health and Human Services (“HHS”) proposed new regulations implementing Section 1557 of the Patient Protection and Affordable Care Act (“ACA”). Section 1557 prohibits...more

Troutman Pepper

Summary of HUD's LEAN 232 Program Email Blast Office of Residential Care Facilities (ORCF) August 28, 2015

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The August 28, 2015 LEAN Email Blast contains information on the final rule regarding fire safety equipment, the new delegated underwriter approval process, the Green Lane, and the mortgage termination process, among other...more

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