Hospice Insights Podcast - Hospice Audit Updates: Hospices Fare Well in Federal Court
Hospice Insights Podcast - Election Inspection: Be Proactive to Avoid Costly Election Statement Denials
(Podcast) California Employment News – Key Rules for California Employers: Business Expense Reimbursement
California Employment News – Key Rules for California Employers: Business Expense Reimbursement
AGG Talks: Home Health & Hospice - Reimbursement Audits and Appeals
Podcast: Direct Access Laboratory Testing: Reimbursement & Compliance – Diagnosing Health Care
Podcast: Owner's Outlook: Maximize and Safeguard Reimbursement Through Design - Diagnosing Health Care
HealthLaw HotSpot - A Look at Alternative Reimbursement Models in Value-Based Care
The Important and Thriving Role of Private Medical Practices
Value-Based Care and Its Impact on Providers
The Year Ahead: Litigation Hot Spots at a Glance
Teleworking: Amazing or amazingly complex?
(Video) Reimbursement of College Tuition and Fees After COVID-19
Value-based health care: compliance infrastructure
K&L Gates Triage: 340B Eligibility - Hospital Covered Entities
Value-based health care: fraud & abuse laws
Value-based health care: issues for pharmaceutical companies
Condo Water Invasion: Potential Medical Liability?
Many employers have faced the same “knot in the stomach” moment during insurance renewal season. We’re all too familiar with the stress of inexplicably rising health care costs, especially when group plan risk pools take an...more
Pursuant to 42 U.S.C. § 4081(a), the Federal Emergency Management Agency (FEMA) is authorized to engage private insurers to sell National Flood Insurance Program (NFIP) policies under the Write Your Own (WYO) program....more
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
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
Two recent announcements from the Centers for Medicare & Medicaid Services (CMS) offer early indicators as to how the Trump administration, including CMS administrator Dr. Mehmet Oz, may approach the Medicare Advantage (MA)...more
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
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
On December 19, 2024, the Fair Housing Administration (FHA) and the U.S. Department of Housing and Urban Development (HUD) published a draft Mortgagee Letter proposing a new Optional Reimbursement Claim Alternative (ORCA)...more
Take a deep breath. Losing one’s home or business to a fire is devastating and the road to recovery will be long and winding. First and foremost, you need to take care of yourself and your family. Make sure everyone is safe,...more
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
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
Minnesota AG Keith Ellison has reached a settlement with BCBSM, Inc. d/b/a Blue Cross and Blue Shield of Minnesota, and HMO Minnesota d/b/a Blue Plus (collectively, “Blue Cross”) to resolve allegations that the insurer...more
Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate...more
In a victory for all insureds who have title insurance policies, and possibly a victory for insureds under other real property related insurance policies, the California Court of Appeal in Tait v. Commonwealth Land Title...more
No health insurance benefit program, no matter how high profile, is immune to the temptations of insurance fraud. In the past, multiple former NFL players pleaded guilty to defrauding the NFL Player Health Reimbursement...more
Artificial intelligence (AI) has the power to revolutionize health care. In oncology, there are now opportunities to apply AI to support diagnostics, predictive analytics, and administrative functions. This hot topic was...more
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
This month’s Friday Five explores recent decisions with issues spanning physician power of attorney to preexisting exclusions and the fiduciary duty of an insurance company....more
In Florida, personal injury protection (PIP) coverage limits reimbursement of medical charges to 80% of “all reasonable expenses.” What is “reasonable” is generally determined by a statutory schedule of maximum charges...more
In Patterson v. United Healthcare Insurance Company, 76 F.4th 487 (6th Cir. 2023), the Sixth Circuit held that the plaintiff insured had stated an equitable claim for disgorgement under ERISA where he sought disgorgement of...more
Fine Art Title Insurance Artwork title insurance reimburses an insured if another owner makes a claim to the title of a piece of artwork that the insured purchased. This is an important coverage, which is often purchased...more
Weighing in on an issue that has divided courts nationwide, the U.S. Court of Appeals for the First Circuit has ruled that an insurer under Massachusetts law has no right to recoup defense costs, or amounts the insurer pays...more
In Part I (”When Can an Insurer Pursue a Malpractice Claim Against Defense Counsel Retained for an Insured”) of our two-part article published by the ABA’s Insurance Coverage Litigation Committee (ICLC), we addressed the...more
1. German Federal Court of Justice rules on reimbursement of disputed workshop invoices by insurance companies - On 16 January 2024, the German Federal Court of Justice (Bundesgerichtshof, “BGH”) decided five cases, all...more
Orange Cty. Sch. Bd., a/k/a Orange Cty. Public Schools, County Court 9th Judicial Circuit Orange County, Civil Division, Case No: 2021-CC-016105-O - State Farm sought reimbursement from the School Board of Orange County for...more