News & Analysis as of

Hospitals Insurance Industry

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

Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - July 2025 #2

News Briefs - Tariffs May Impact Hospice Mergers and Acquisitions Activity - Tariffs being implemented by the Trump administration could have a dampening effect on an already slumping hospice mergers and acquisitions market....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

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

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - June 2025 #2

News Briefs - Appeals Court Set to Rehear No Surprises Case - An appeals court is set to rehear a case from providers trying to restrict what factors insurers consider in calculating a key metric that arbiters use to...more

A&O Shearman

Northern District Of Illinois Denies Motion To Dismiss Antitrust Claims In Healthcare Providers’ Price Fixing Lawsuit

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On June 3, 2025, Judge Matthew F. Kennelly denied motions to dismiss federal and state antitrust claims brought by healthcare providers (“plaintiffs”) against MultiPlan (a healthcare payment management service) and...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

Goodwin

Health Headlines: May 2025

Goodwin on

On May 14, 2025, Pennsylvania State Sen. Tim Kearney and State Rep. Lisa Borowski introduced legislation addressing private equity and corporate interests in healthcare. Pennsylvania Gov. Josh Shapiro is touting the companion...more

Fox Rothschild LLP

Florida’s Medical Malpractice Reform: Navigating the Shifting Landscape for Providers

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Florida’s healthcare providers and their insurers are on the verge of a significant adjustment to the state’s medical malpractice landscape. For over three decades, a controversial provision within Florida’s medical...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

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - March 2025

The giant firms  that track trends for big businesses have glum news for all of us: Health care costs are spiking anew this year. The rise, one consultancy predicts, will be the highest in 13 years....more

Tyson & Mendes LLP

Shining Light on Phantom Medical Bills–Lessons from Washington on Using Federal Hospital Price Transparency Rules to Fight Back

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How many of you reading this have had this experience: you get a settlement demand with hundreds of thousands of dollars in claimed hospital bills, but the actual amount owed by the claimant is redacted, or you are told by...more

Health Care Compliance Association (HCCA)

Early returns on MA plans’ two-midnight rule interpretations: A compliance nightmare

The Centers for Medicare and Medicaid Services (CMS) issued regulations applicable to Medicare Advantage (MA) plans—also commonly referred to as managed Medicare or Part C Medicare—in April 2023 (CMS 4201–F) that address,...more

Spilman Thomas & Battle, PLLC

The Health Record - Healthcare Law Insights, Issue 3, July 2024

Welcome to our third issue of The Health Record - our healthcare law insights e-newsletter! We are winding down the summer with our talented group of law students and they have continued to research and write, shadow...more

McDermott+

Regs, Regs and More Regs: The Biden Administration Releases Spring 2024 Unified Agenda

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We are in the midst of a storm of regulations that are being released by the Centers for Medicare & Medicaid Services (CMS) and the US Department of Health and Human Services (HHS), including the Calendar Year (CY) 2025...more

Perkins Coie

Expansion of Hospital Tort Liability in Washington

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The Washington State Supreme Court significantly expanded the scope of potential hospital tort liability for the allegedly negligent actions of nonemployee, independently contracted emergency room service physicians, and...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

Mitratech Holdings, Inc

What is Recruitment Marketing Software?

Are you struggling to attract, engage, and hire top talent for your organization? As the war for talent rages, traditional recruitment methods may no longer be enough. That’s where recruitment marketing software comes in....more

Kennedys

New trends in fragment billing: Non-facility companies billing for facility-bundled services

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When one receives surgery, it is common to receive a separate invoice from the physician and the facility. The physician bills for performing the surgery, and the facility bills for providing the products and services...more

Bass, Berry & Sims PLC

Sutter Health Prevails in Antitrust Trial Arising from Its Contracting Practices

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On March 11, a California federal jury delivered a verdict in favor of Sutter Health, one of the nation’s largest hospital systems, in a $411 million class-action lawsuit alleging Sutter’s contracts with insurers unlawfully...more

King & Spalding

Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals and Insurance Companies

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On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the...more

Saul Ewing LLP

Lost the Battle, Still Looking to Fight the War — the FTC Presses Forward on All Fronts to Stop Jefferson-Einstein Merger

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Faced with a December 8, 2020, Memorandum and Order by Eastern District Judge Pappert (link) denying the Federal Trade Commission’s (FTC’s) request to enjoin the proposed Jefferson-Einstein merger, and the resulting right of...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

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