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Benesch

Dental/DSO Intelligence Monthly Report: July 2025

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As government scrutiny of the healthcare industry intensifies, enforcement agencies are casting wider nets to recover funds based on narrowly interpreted violations. This puts not only healthcare providers but also those...more

Foley & Lardner LLP

Risk Bearing Entity Requirements: Massachusetts

Foley & Lardner LLP on

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

Stotler Hayes Group, LLC

Common Medicaid Application Mistakes: Errors to Avoid During the Application Process

Stotler Hayes Group, LLC on

The Medicaid application process can be complicated. However, there are several common mistakes made by filers that can make things even more difficult than they need to be, adding unnecessary obstacles. In this article, we...more

Wiley Rein LLP

[Podcast] Contracting for Success: Key Legal Considerations When Segmenting Pharmacy Benefit Programs

Wiley Rein LLP on

In this episode of The Wiley Contracting Chronicles, co-hosts Jordan Ross and Brooke DeLoatch take a deeper dive into program segmentation within pharmacy benefit programs. After outlining the concept in their previous...more

Foley & Lardner LLP

Risk Bearing Entity Requirements: New Jersey and New York

Foley & Lardner LLP on

This blog reviews the regulatory requirements that apply to risk bearing entities (RBE) in New Jersey and New York. New Jersey and New York demonstrate distinct approaches to the registration and regulation of RBEs and...more

McDermott Will & Schulte

How PPM Health Plans Can Solve the MEWA Problem

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While a physician practice management (PPM) structure allows for compliance with corporate practice of medicine laws and ease of administration, it often creates inadvertent health plan issues that should be navigated...more

McDermott Will & Schulte

Special Report: Examining Group Health Coverage Alternatives for Small Employers

McDermott Will & Schulte on

Small employers seeking to offer robust major medical coverage to employees and their dependents face daunting price and transparency hurdles. Employers with 50 or fewer full-time equivalent employees, so-called “small...more

Stotler Hayes Group, LLC

CMS Cracks Down on Responsible Party Liability in LTC Admission Agreements

Stotler Hayes Group, LLC on

A nursing facility that participates in the Medicaid or Medicare programs may not require a third party to guarantee payment for a resident’s admission or continued stay. However, facilities are allowed to require a resident...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

Polsinelli

Ten Individuals Charged in Business Email Compromise Scheme Targeting Medicare, Medicaid and Other Insurers

Polsinelli on

On November 18, 2022, the U.S. Department of Justice (“DOJ”) announced charges against ten defendants across Georgia, South Carolina and Virginia, resulting from a scheme that allegedly targeted Medicare, state Medicaid...more

Buchalter

The DMHC’s Final Guidance on the General Licensure Regulation (“Restricted Health Plans”) The Lull Before the Storm

Buchalter on

On Friday, June 14, 2019 the Department of Managed Health Care (the “Department”) issued All Plan Letter 19-014 (OLS) (“APL”) containing its formal guidance regarding implementation of the General Licensure Requirements (for...more

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