Your prescribed dose of health law news
On May 28, the U.S. Department of Health and Human Services (HHS) finalized regulations intended to make the Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA) more efficient and transparent in helping to resolve out-of-network payment disputes between healthcare providers and payors.
Under the IDR process, insurers and healthcare providers both file…
[Note: On May 28, HHS finalized new regulations on the IDR process, as discussed here.]
The No Surprises Act (NSA), enacted in 2020, was designed to protect patients from unexpected medical bills in certain healthcare settings. The law primarily applies when a patient receives emergency care at either an in-network or out-of-network facility, or…
On March 26, the U.S. Department of Justice (DOJ) and the U.S. Attorney’s Office for the Southern District of New York filed a civil antitrust lawsuit against The New York and Presbyterian Hospital (NYP). The Complaint alleges that NYP violated Section 1 of the Sherman Act by requiring restrictive anti-competitive language in its commercial contracts…
A STAT News article, “How a Texas Couple is Getting Rich Off Out-of-Network Medical Bills,” explores how entrepreneurs Scott and Alla LaRoque built profitable businesses like MPOWERHealth, an intraoperative neuromonitoring company, by finding ways to exploit the 2020 No Surprises Act—a law intended to protect patients from unexpected medical bills by out-of-network providers.
On March 11, the U.S. Department of Justice and U.S. Attorney’s Office announced that Aetna, a national health insurer, has agreed to pay $117,700,000 to settle alleged violations of the False Claims Act (FCA). The government was investigating Aetna for submitting inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan beneficiaries, which increased Aetna’s…
Westside Behavioral Care Inc., a Colorado mental health clinic, recently sued Kaiser Foundation Health Plan of Colorado for prematurely terminating its participation agreement. Kaiser terminated the agreement in an effort to increase the provision of services through a less costly telehealth model.
The clinic is alleging that the early termination disrupted care for more than…
On Thursday, September 18, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Chris Kutner and Ashley Algazi will present “How to Handle Payer Record Request and Subsequent Demand for Alleged Overpayments.”
The presentation will provide a comprehensive review of the issues and best practices for responding to, and defending against, payer audits.
The New York Attorney General’s office recently announced an agreement with MVP Health Care under which the insurer will pay $250,000 in penalties, fees, and costs to the state for maintaining an inaccurate mental health provider directory. The settlement is the first arising out of an investigation of so-called “ghost networks” by Attorney General Letitia…
The U.S. Department of Justice recently issued a press release concerning a Statement of Interest that shields small businesses from being forced to provide medical coverage for gender dysphoria.
In Bernier v. Turbocam et al., the Plaintiff, who identifies as a woman and has been diagnosed with gender dysphoria, claims denial of “medically necessary”…
Cigna filed a lawsuit on June 24 in Manhattan federal court accusing Bristol Myers Squibb of unlawfully blocking generic versions of its blood cancer drug, Pomalyst, from entering the market. The suit also names Celgene, a Bristol Myers subsidiary that originally developed and marketed the drug. Cigna alleges that Celgene violated U.S. antitrust laws by…
