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Reimbursements Department of Health and Human Services (HHS) Insurance Industry

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

Pietragallo Gordon Alfano Bosick & Raspanti,...

The Medicare Advantage Program: Public Money & Private Insurance Companies

When I investigated and litigated False Claims Act (FCA) cases at the U.S. Department of Justice (DOJ) over the last 10 years, I was often surprised by just how little I knew about the broad array of government agencies and...more

ArentFox Schiff

No More Surprise Medical Bills: Fifth Circuit Affirms Vacatur of Arbitration Provisions of Surprise Billing Rules (TMA II)

ArentFox Schiff on

On August 2, health care providers scored yet another significant victory when the US Court of Appeals for the Fifth Circuit affirmed the vacatur of various federal regulations regarding the arbitration procedures used to...more

Bradley Arant Boult Cummings LLP

The COVID-19 Home Game: Biden Administration Requires Insurance to Cover At-Home Tests

In light of the difficulty of test scheduling and concerns about costs to consumers, the Biden administration this week announced that the Department of Health and Human Services will require private health insurance and...more

Sheppard Mullin Richter & Hampton LLP

Tri-Agencies Release Guidance on Coverage of OTC COVID-19 Tests

On January 10, 2022, the U.S. Department of Health & Human Services, Department of Labor, and the Treasury (“Tri-Agencies”) published guidance about how health plans and health insurance issuers must reimburse OTC COVID-19...more

Seyfarth Shaw LLP

Supreme Court Rules Government Must Pay $12 Billion to Health Insurers Under ACA Risk Corridor Program

Seyfarth Shaw LLP on

On April 27, 2020, the US Supreme Court ruled by an 8-1 decision that the federal government must pay billions of dollars to health insurers who sold consumer policies on exchanges under the Affordable Care Act’s (“ACA”)...more

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